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HEALTH  SCIENCES  STANDARD 


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Digitized  by  tine  internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/preventionofdiseOOunit 


DEPARTMENT  OF  COMMERCE 

LIGHTHOUSE  SERVICE 


PREVENTION  OF  DISEASE 
AND  CARE  OF  THE 
SICK  AND  INJURED 

MEDICAL  HANDBOOK  FOR  THE  USE  OF 
LIGHTHOUSE   VESSELS  AND   STATIONS 


1915 


Revised  by  W.  G.  STIMPSON,  M.  D. 

Assistant  Surgeon  General,  United  States  Public  Health  Service 
WITH  A  SUPPLEMENT  ON 

FIRST  AID  TO  THE  INJURED 

By  R.  M.  WOODWARD,  M.  D. 

Surgeon,  United  States  Public  Health  Service 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1915 


ADDITIONAL  COPIES 

OF  THIS  PUBLICATIO^f  MAT  BE  PROCURED  FROM 

THE  SUPERINTENDENT  OF  DOCUMENTS 

GOVERNMENT  PRINTING  OfTICE 

WASHINGTON,  D.  C. 

AT 

50  CENTS   PER   COPY 


CONTENTS. 


List  of  medical  and  surgical  supplies " 

Sanitation - " 

Use  of  clinical  thermometer 13 

Malarial  fever l^ 

Measles - : 1^ 

Smallpox 18 

Scarlet  fever 22 

Diphtheria 24 

Sore  throat 25 

Mumps 26 

Coughs  and  colds " ' 

Consumption 28 

Typhoid  fever 29 

Delirium  tremens 31 

Sunstroke 32 

Headache 33 

Erysipelas 34 

Poison  ivy 34 

Boils - 35 

Fainting - 35 

Dysentery 36 

Diaii'hea 37 

Cholera  morbus 38 

Colic 39 

Appendicitis 40 

Piles 41 

Scurvy -  42 

Rheumatism 42 

Syphilis 45 

Soft  chancre  (chancroid) 46 

Gonorrhea 48 

Stricture 49 

Venereal  prophylaxis 50 

FIRST   AID   TO   THE    INJURED. 

Rules 51 

Bleeding  (hemorrhage) 51 

Broken  bones 57 

Dislocations 73 

Sprains 80 

Wounds 81 

Bruises  and  contusions 84 

Foreign  bodies  in  the  eye,  ear,  nose,  and  throat 84 

Burns  or  scalds 86 

Drowning ' 88 

Gas  poisoning 91 

3 


4  CONTENTS. 

Page. 

Electric  Bhock 92 

Bites  and  etings  of  poisonous  animals  or  insects 93 

Effects  of  cold— frostbite 95 

Ruptui-e 95 

Antisepsis,  antiseptics,  and  tlie  dressing  of  wounds 96 

Bandaging. 98 

Transportation  of  injured 108 

Poisons  and  antidotes - 110 

A  list  of  don'ts 114 

Index 115 


mEDICAL  HANDBOOK  FOR  THE  USE  OF  LIGHTHOUSE 
VESSELS  AND  STATIONS. 


Department  of  Commerce, 

Bureau  of  Lighthouses, 
Washington,  D.  C,  June  11,  1915. 

This  handbook  has  been  prepared  for  the  benefit  of  officers  and 
employees  of  the  Lighthouse  Service,  whose  duty  on  vessels  and  at 
remote  stations  may  render  it  difficult  at  times  for  them  to  obtain 
necessary  medical  assistance  or  advice.  In  all  cases  of  serious  sick- 
ness or  injury,  however,  medical  attendance  should  be  obtained  as 
soon  as  practicable.  Written  directions  must  very  imperfectly  supply 
the  place  of  the  physician  and  surgeon.  With  a  medicine  chest  and 
handbook  it  is  not  possible  to  provide  for  and  explain  to  persons  who 
have  not  had  a  medical  education  the  treatment  of  more  than  a  few 
of  the  commoner  diseases. 

Medicine  chests,  equipped  with  the  Hst  of  articles  given  herein, 
wiU  be  suppHed  to  the  vessels  and  remote  stations,  as  approved. 
Such  chests  must  be  kept  accessible,  frequently  inspected,  and  fully 
equipped.  The  dates  when  obtained  must  appear  on  all  medicines 
and  packages,  and  they  must  be  renewed  when  no  longer  serviceable, 
according  to  the  length  of  time  stated  in  the  hst  of  medicines  and 
articles. 

Sick  or  disabled  persons  emploj^cd  on  vessels  of  the  Lighthouse 
Service  will  be  admitted  without  charge  to  relief  stations  of  the  United 
States  Public  Health  Service  upon  apphcation  of  their  respective 
commanding  officers. 

This  handbook  is  a  revision  for  the  use  of  the  Lighthouse  Service 
of  the  Medical  Handbook,  1912,  revised  by  W.  J.  Pettus,  Assistant 
Surgeon  General,  from  the  Handbook  for  the  Ship's  Medicme  Chest, 
prepared  by  George  W.  Stoner,  surgeon.  United  States  Pubhc  Health 
Service,  by  direction  of  the  Surgeon  General  of  that  service. 

G.  R.  Putnam, 
Commissioner  of  Liglithouses. 

5 


LIGHTHOUSE   SERVICE. 

LIST  OF  MEDICAL  AND  SURGICAL  SUPPLIES. 

Medical  supplies. 
[Supplies  for  Lighthouse  Service  medicine  chests  are  marked  with  an  asterisk,  thus:  (*).] 


For  vessels. 


For  stations. 


Item. 


*1  pound. 

1  pint. .. 

^  pound . 
*|  pint.  . . 

*100 

*1  yard... 
*4  ounces, 
noo 


*100 

^  pound . 
*1  pound . 

*100 

*100 

*100 


*100 

i  pint. .. 
*1  pint.  - . 
*1  pint.  . . 

^  pound . 
*100 

100. .... 

*100 

*1  ounce. 

1  pint.  . 

1  ounce. 


*2  pounds. 

^  pint.  .  - 

4  ounces. 

ipint.... 

1  pound.. 

1  pint 

*1  pint 

*100 

*4  ounces. 

1  pint 


^  poimd. 
*^  pound. 

1  ounce. 
*1  pint... 
*i  pint. . . 

100 

1  pint. . . 

1  pint... 

*100 

*100 

100 

i  pint. . . 
*1  quart. . 

*100 

*100 


■*1  pound . 

4  pint.  . . 

4  ounces. 
*4  ounces. 

*100 

*1  yard... 
*4  ounces. 
*100 

*100 

4  ounces. 
*^  pound . 

*100 

*100 

*100 

*100 

4  ounces . 
*  J  pint . .  - 
*ipint.  .. 

4  ounces. 
*100 

100 

*100 

*^  ounce. . 

^  pint.  . 

1  ounce . . 

*1  pound . 
4  ounces, 

2  ounces 
4  ounces 
J  pound. 
1  pint... 

*.V  pint..- 

*ioo 

*2  ounces 
t1-  pint... 

4  ounces 
*4  ounces 

^  ounce. 
*1  pint... 
*4  oimces 

100 

1  pint... 

^  pint. . . 

*100 

*100 

100 

4  ounces 
*1  pint... 

*100 

*100 


Absorbent  cotton. 

Alcohol. 

Alum. 

Aromatic  spirit  of  ammonia. 

Aspii'tn,  5-grain  tablets. 

Belladonna  plaster  (1  year). 

Bicarbonate  of  soda  (baking  soda). 

(Poison)  Bichloride  of  mercury,  antiseptic  tab- 
lets of  7.3  grains  each.  One  tablet  to  a  pint 
of  water  makes  solution  1  part  of  bichloride  to 
1,000  of  water. 

Bismuth  subnitrate,  5-gi'ain  tablets. 

Borax. 

Boric  acid  (boracic  acid),  powdered. 

Bromide  of  potash,  5-grain  tablets. 

Brown  Mixtm-e  lozenges. 

Calomel,  ^-grain  tablets,  amber-colored  bottle 
(1  year). 

(Poison)  Camphor  and  opiimi  pills. 

Camphorated  oil. 

(Poison)  Carbolic  acid,  liquid,  pure. 

Castor  oil. 

Charcoal. 

Chlorate  of  potash,  5-grain  tablets. 

Compotmd  Cathartic  Pills,  vegetable. 

Copaiba,  5-minim  capsules. 

(Poison)  Creosote,  Beechwood. 

Dobell's  Solution. 

Ear  drops,  formula:  Carbolic  acid,  1  fluid 
drachm;  glycerin,  7  fluid  drachms;  well  mixed. 

Epsom  salts. 

Essence  Jamaica  ginger. 

Essence  of  peppermint. 

Essence  of  pepsin. 

Flaxseed  meal  (linseed  meal). 

(Poison)  Formalin  (1  year). 

Glycerin. 

Iodide  of  potash,  5-grain  tablets. 

(Poison)  Laudanum  (1  year). 

(Poison)  Lead  and  opium  wash.  Shake  well 
before  using. 

Magnesia,  calcined,  heavy. 

Mustard. 

(Poison)  Oil  cloves. 

Olive  oil  (sweet  oil). 

(Poison)  Paregoric. 

Permanganate  of  potash,  5-grain  tablets. 

Peroxide  of  hydrogen  solution  (1  year). 

(Poison)  Picric  acid,  fj  per  cent  solution. 

Quinine  sulphate,  5-grain  tablets. 

Salicylate  of  soda,  5-grain  tablets. 

Salol,  5-grain  tablets. 

Sirup  of  ipecac. 

Soap  liniment. 

(Poison)  Strychnine  sulphate,  -^-grain  tablets. 

(Poison)  Suia  Cholera  Mixture,  15-minim  tab- 
lets. 


MEDICAL  HANDBOOK. 

LIST  OF  MEDICAL  AND  SURGICAL  SUPPLIES— Continued. 

Medical  supplies — Continued. 


For  vessels. 

For  stations. 

Item. 

^  pint 

4  ounces 

4  ounces 

J  pint 

*4  ounces 

4  ounces 

*4  ounces 

i  pint 

Sweet    spirit   of    niter,    dark-colored    bottle    (1 

year). 
Tannic  acid. 
Tincture  of  green  soap. 
(Poison)  Tincture  of  iodine  (1  year). 
Tincture  of  iron. 

i  pound 

1  pint 

*A  pint 

i  pint 

*i  pint 

Tincture  of  myrrh. 

Turpentine. 

Unguentine  (for  bums,  scalds,  etc.). 

Vaseline. 

(Poison)  Zinc  sulphate  (white  vitriol),  15-grain 

powders.     (One  powder  in  water  to  produce 

vomiting.) 

1  pint 

1  pound 

*1  pound 

6  powders 

1  pound 

*^  pound 

6  powders 

These  medicines  will  remain  serviceable  until  used  if  kept  in  glass- 
stoppered  bottles,  with  the  exception  of  those  marked  "  1  year," 
which  should  be  renewed  after  that  interval.  The  containers  of  all 
articles  marked  "  1  year"  should  be  plainly  marked  with  the  date  on 
which  such  articles  are  received. 

For  bulky  articles  not  over  a  pint  of  each  need  be  kept  in  the  medi- 
cine chest. 

Special  bottles  with  a  rough  surface  must  be  used  for  poisonous 
medicmes.     These  bottles  must  be  plainly  marked  Poison. 

Doses  for  children. — ^Add  12  to  the  age  of  the  child  and  divide  the 
age  of  the  child  by  this  sum.  This  fraction  will  represent  the  size  of 
dose  compared  with  that  for  an  adult.     Example:  For  a  child  2  years 

2  2         1 

old  2  I  lo'^TT  or  -^')   the  dose  is  one-seventh  of  that  for  an  adult. 

Surgical  supplies,  etc. 
[Supplies  for  Lighthouse  Service  medicine  chests  are  marked  with  an  asterisk,  thus:  (*).] 


For  vessels. 

For  stations. 

Item. 

*2 

*1... 

Adhesive  plaster,  10-yard  reel,  1  inch  wide. 
Applicators,  small,  wooden. 
Atomizer      De  Vilbiss. 

2  dozen 

1 

1  dozen 

*1  dozen 

1  dozen 

*1  dozen 

1  dozen 

1  dozen 

2... 

Bandages: 

2-inch  by  3-yard  (one-half  dozen  gauze  and 

one-half  dozen  muslin). 
3-inch  by  5-yard  (one-half  dozen  gauze  and 

one-half  dozen  muslin). 
4-inch  by  5-yard  (muslin) . 
Bandages,  plaster  of  Paris,  3-inch.     Each  con- 
tained in  an  air  and  moisture  proof  container. 
Bandages,  triangular  (Esmarch's  bandage),  with 
figures  printed  on  them  showing  the  various 
ways  they  can  be  used. 
Camel  's-hair  brushes 

1  dozen 

4 

6 

6. 

6 

3 

n 

*1 

Catheter,  rubber.  No.  20  F.  (1  year). 

LIGHTHOUSE   SERVICE. 


LIST  OF  MEDICAL  AND  SURGICAL  SUPPLIES— Continued. 
Surgical  supplies,  etc. — Continued. 


For  vessels. 


For  stations. 


Item. 


10  yards. 

''■10  yards . 
1 


C 

1 

2 

2  dozen. 
1 


*1 

*2 

*i 

1 

1... 

4  pieces. 

4  sheets . 


1 

1 

1 

1 

5  yards. 

*5  yards . 
1 

6 

1 

2 

2  dozen. 
1 

1 

3 

*1 

*2 

*1 

1 

1 

2  pieces 

2  sheets 


Corkscrew. 

Forceps,  artery  (hemostatic  forceps).  This  can 
be  used  to  grasp  a  bleeding  vessel  until  it  can  be 
tied,  or  until  the  doctor  arrives.  A  catch 
holds  the  grip  of  the  forceps.  Sterilize  by 
boiling. 

Forceps,  dressing,  or  dissecting.  Will  be  found 
convenient  in  cleaning  up  a  wound  and  ap- 
plying dressings;  also  in  removing  splinters, 
etc.     Sterilize  by  boiling. 

Fountain  syringe,  2-quart  (1  year). 

Gauze,  picric  acid.  Good  dressing  for  wounds 
and  scalds. 

Gauze,  plain,  sterile. 

Hot- water  bottle,  rubber,  2-quart  (1  year). 
Metal  bottle  preferred. 

Medicine  droppers. 

Medicine  glass. 

Nail  brushes. 

Safety  pins,  large. 

Scissors,  dressing,  surgeon 's,  for  cutting  gauze  and 
bandages.     Sterilize  by  boiUng. 

Shears,  for  cutting  cotton  and  muslin,  etc. 

Splints,  wooden.  Straight  and  angular  splints 
made  of  thin  board,  as  described  in  chaj^ter  on 
"Fractures." 

Spool  of  silk  ligature,  medium  size. 

Surgical  needles,  in  glass-stoppered  bottles. 

Thermometer,  clinical,  Fahrenheit. 

Tooth  forceps,  incisor. 

Tooth  forceps,  molar. 

Wire  gauze,  made  of  heavy  mesh  malleable  wire. 
When  well  padded  can  be  wrapped  around  a 
fracture  for  temporaiy  dressing. 

Yucca  palm  (a  thin  fiber  board).  Can  be 
wrapped  around  fracture  for  temporary  dress- 
ing. 


Gauze  and  bandages  should  be  in  paraffin-paper  packages,  sealed 
after  sterilization. 

Catheters  and  other  rubber  goods  should  be  in  sealed  paraffin  pack- 
ages or  envelopes,  slightly  dusted  with  sterile  talcum  on  the  inside 
of  the  package. 

Scissors  and  instruments,  if  not  in  cases,  may  be  coated  with  par- 
affin, which  will  come  off  when  dipped  in  hot  water. 

Articles  marked  "1  year"  should  be  discarded  after  that  interval 
and  new  ones  obtained.  The  containers  of  all  articles  marked  "  1 
year"  should  be  plainly  marked  with  the  date  on  which  such  articles 
are  received. 


MEDICAL   HAlfDBOOIt.  9 

SANITATION. 

On  vessels. — The  master  of  a  vessel  should  observe  the  following 
measures  on  board  his  vessel,  and  the  same  rules  should  be  applied  at 
light  stations,  so  far  as  useful: 

The  water-closets,  forecastle,  bilges,  and  similar  portions  of  the 
vessel  liable  to  harbor  infection  should  be  frequently  cleansed. 

Free  ventilation  and  rigorous  cleanliness  should  be  maintained  in 
all  portions  of  the  ship  during  the  voyage  and  measures  taken  to 
destroy  rats,  mice,  fleas,  flies,  roaches,  mosquitoes,  and  other  vermin. 

Everyone  on  board  a  vessel  or  on  duty  at  a  light  station  should  be 
provided  with  a  separate  towel,  soap,  and  drinking  cup  for  his  mdi- 
vidual  use  in  order  to  prevent  conveyance  of  disease  from  one  person 
to  another.  Water  butts  should  have  spigots  and  tight-fitting  tops 
secured  by  lock  and  key  to  prevent  seamen  from  dipping  their  cups 
into  the  water. 

A  patient  sick  of  a  communicable  disease  should  be  isolated  and 
one  member  of  the  crew  detailed  for  his  care  and  comfort,  who,  if 
practicable,  should  bo  immune  to  the  disease. 

Communication  between  the  patient  or  his  nurse  and  other  persons 
on  board  should  be  reduced  to  a  minimum. 

Used  clothing,  body  linen,  and  bedding  of  the  patient  and  nurse 
should  be  immersed  in  boiling  water  or  m  a  3  per  cent  solution  of 
carbolic  acid  before  removal  from  room,  and  should  be  kept  so 
immersed  for  1  hour. 

Eating  and  drinldng  utensils,  after  being  used  by  the  patient, 
should  be  washed  m  boiling  water.  They  should  not  be  used  by  others 
until  they  have  been  sterilized  by  boiling. 

The  compartment  from  which  the  patient  was  removed  should  be 
disinfected  and  thorouglily  cleansed. 

Any  person  suffering  from  malarial  fever  should  be  kept  under 
mosquito  bars  and  the  apartment  in  which  he  is  confined  closely 
screened  with  mosquito  netting.  All  mosquitoes  on  board  should  be 
destroyed  by  burning  Pyrethrum  powder  (Persian  insect  powder) 
or  sulphur,  in  pots,  2  pounds  to  1,000  cubic  feet  air  space,  the  room 
or  compartment  to  be  closed  for  2  hours.  The  pots  should  be  placed 
upoii  metal  or  in  utensils  containing  water  in  order  to  guard  against 
fire.  If  Pyrethrum  powder  is  used  the  stupified  mosquitoes  should  be 
swept  up  and  burned  after  the  fumigation,  as  otherwise  they  may  again 
become  active.  Mosquito  larvse  (wigglers  or  wiggle  tails)  should  be 
destroyed  in  water  barrels,  casks,  and  other  collections  of  water  about 
the  vessel  by  placmg  a  thin  layer  of  petroleum  (kerosene)  on  top  the 
water.  Wlierc  this  is  ]iot  practicable,  use  mosquito  netting  to  pre- 
vent the  exit  of  mosquitoes  from  such  breeding  places. 


10  LIGHTHOUSE   SERVICE. 

Formulas  for  disinfecting  solutions  recommended  for  use. 

Bichloride  of  mercury  ^  (1:1,000): 

Bichloride  of  mercury '         1 

Sea  water 1,  000 

Carbolic  acid  ^  (3  per  cent) : 

Carbolic  acid,  pure 30 

Hot  fresh  water 1,  000 

Flies  as  carriers  of  disease. — It  is  a  well-known  fact  that  flies  carry 
the  germs  of  such  well-known  diseases  as  tuberculosis,  typhoid  fever, 
and  probably  smallpox;  hence  the  importance  of  preventing  their 
breeding  near  a  dwelling  or  securing  access  to  a  house.  They  breed 
in  such  things  as  stable  manure,  garbage,  etc.,  in  from  8  to  10 
days  after  the  eggs  are  deposited.  The  fly  deposits  its  eggs,  which 
in  a  few  days  hatch  mto  a  white  worm,  popularly  called  the  maggot, 
then  turnmg  into  the  fly.  If  there  is  a  stable  near  the  lighthouse, 
the  manure  should  be  removed  and  buried  every  5  days  or  it  should 
be  protected  from  the  access  of  flies  b}^  screening  or  some  similar 
method.  All  garbage  not  immediately  buried  or  burned  should  be 
placed  m  cans,  protected  by  tops,  so  that  the  flies  can  not  get  in. 
All  openings  to  the  house  should  be  protected  by  wire  netting,  prefer- 
ably bronze  wire,  16  mesh  to  the  inch;  if  mosquitoes  are  present  the 
mesh  should  be  18  to  the  mch. 

Mosquitoes. — Mosquitoes  are  known  to  convey  such  diseases  as 
malarial  and  yeUow  fever  by  biting  a  person  sick  with  this  disease 
and  afterwards  inoculating  other  persons  by  biting  them.  They 
breed  usually  in  stagnant  water.  The  eggs  are  deposited  on  the 
surface  of  the  water  and  are  hatched  out  first  in  the  form  of  what  is 
known  as  wiggle  tails  or  wigglers.  At  the  end  of  about  10  days  these 
wigglers  go  through  certain  changes  and  become  full-fledged  mosqui- 
toes. It  is  important  that  no  water  be  allowed  to  stand  in  containers 
about  the  dweUing  for  a  period  as  long  as  eight  days.  If  there  are 
such  containers,  they  should  be  emptied  every  five  or  six  days  or  pro- 
tected by  a  netting,  so  that  the  mosquitoes  can  not  obtain  access  to 
lay  their  eggs.  Empty  cans  and  bottles  should  not  be  allowed  to  lie- 
around  the  yard.  The  screens  mentioned  above  properly  applied  to 
all  openings  of  the  house  will  prevent  the  entrance  of  mosquitoes.  A 
few  will  get  in  when  doors  are  opened,  so  the  dweUing  should  be 
searched  each  day  and  aU  mosquitoe&  found  destroyed.  All  persons 
in  malarial  regions  should  sleep  under  mosquito  bars.  Ponds  are  the 
principal  breeding  ground  of  mosquitoes  and,  if  possible,  they  should 
be  drained  or  oiled  when  near  a  dweUing.  The  malarial  mosquito 
usually  bites  about  sundown  or  during  the  night. 

1  Poisonous  solutions  should  be  colored  blue  with  a  little  laundry  bluing  in  order  to  distinguish  them 
from  nonpoisonous  solutions. 


MEDICAL   HANDBOOK,  ll 

Diet. — In  all  acute  diseases,  especially  those  attended  with  fever, 
the  question  of  diet  is  a  very  important  one,  and  the  main  reliance 
may  be  placed  on  such  food  as  eggs  and  milk.  Thin  soups  may  be 
used,  but  they  contain  very  little  nutrition  and  can  not  be  depended 
upon  to  maintain  the  strength  of  the  sick. 

The  proper  mastication  or  chewing  of  the  food  is  necessary  to 
good  digestion  and  the  maintenance  of  a  healthful  condition.  On 
this  account  the  drinking  of  large  quantities  of  fluid  at  mealtime  is 
objectionable,  as  it  has  a  tendency  to  wash  down  the  solids  before 
they  are  properly  chewed.  It  is  desirable  to  have  the  meals  at  reg- 
ular hours. 

Cleanliness  of  the  person. — A  cold  bath  every  morning  is  probably 
the  best  plan  for  a  person  in  vigorous  health,  but  to  take  one  with 
benefit  there  should  be  a  pleasant  glow  of  exhilaration  afterwards, 
and  it  is  necessary  in  cold  weather  for  the  average  person  to  have  a 
warm  room  in  which  to  take  this  cold  bath.  A  great  many  people 
do  better  with  a  bath  in  tepid  water;  but  it  is  impossible  to  fix  any 
hard  and  fast  rule  in  these  matters. 

The  presence  of  bedbugs  in  dweUings  is  indicative  of  want  of  care 
and  cleanliness  as  to  bed,  bedclothes,  etc.,  and  means  should  be  taken 
to  exterminate  them  when  they  appear.  A  liberal  appUcation  of  ker- 
osene oil  to  the  places  infested  is  probably  the  best  means  of  kilhng 
them. 

Care  of  the  mouth  and  teeth. — It  is  important  to  take  good  care 
of  the  teeth.  If  they  are  allowed  to  decay,  the  food  can  not  be  mas- 
ticated, indigestion  results,  and  the  body  is  not  properly  nourished. 
The  bony  processes  of  the  jaws  which  hold  the  teeth  in  place  are 
absorbed  after  the  teeth  fall  out,  allowing  the  cheeks  to  sink  in, 
which  makes  the  face  look  long  and  thin. 

Dental  decay  is  caused  by  fermentation  of  small  particles  of  food 
which  are  permitted  to  remain  in  the  crevices  between  the  teeth. 
This  fermentation  is  due  to  bacteria  and  results  in  the  formation 
of  acids  which  dissolve  the  Hme  salts  of  the  teeth.  The  hard  white 
outside  coating  of  the  teeth,  known  as  enamel,  is  first  attacked. 
This  is  destroyed  at  spots  where  the  food  is  lodged  and  the  softer 
interior  substance  of  the  tooth  is  exposed;  this  is  rapidly  eaten  away, 
and  a  cavity  is  formed  which  increases  in  size  until  only  a  hollow 
shell  of  enamel  remains.  The  nerves  of  the  teeth  are  extremely  sen- 
sitive, and  severe  pain  or  toothache  is  produced  when  dental  decay 
extends  into  a  tooth.  An  abscess  or  gumboil  may  form  at  the  root 
of  a  tooth.  This  causes  a  throbbing  pain,  sweUing,  and  fever.  It 
usuaRy  breaks  tlu-ough  the  gum,  discharging  pus,  with  rehef  of  the 
symptoms;  sometimes,  however,  the  inflammation  extends  to  the 
bone,  ending  in  its  necrosis  or  death.  Occasionally  pus  organisms 
are  absorbed  into  the  blood  and  blood  poisoning  ensues. 


12  LIGHTHOUSE   SEEVICE. 

An  unclean  mouth  makes  an  ideal  home  for  small  organisms 
known  as  endameba  buccaUs,  which  many  beheve  are  the  cause  of 
pyorrhoea  dentahs  or  Rigg's  disease.  In  this  disease  there  is  inflam- 
mation of  the  gums,  which  become  soft,  swollen,  and  bleed  easily. 
The  disease  extends  around  the  roots  of  the  teeth,  pus  exudes  from 
their  sockets,  they  are  loosened,  and  ultimately  fall  out.  The 
process  may  take  a  number  of  years,  but  more  than  half  of  the 
permanent  teeth  are  lost  in  this  way. 

An  unclean  condition  of  the  mouth  renders  the  person  more  liable 
to  catch  cold,  to  attacks  of  influenza,  bronchitis,  and  pneumonia. 
Headaches  and  neuralgic  pains  arc  often  due  to  bad  teeth.  Many 
cases  of  so-called  rheumatism  result  from  the  absorption  of  poison 
from  the  mouth  and  disappear  when  the  disease  conditions  in  the 
mouth  are  remedied.  The  same  poisons  often  lead  to  sore  throat, 
inflammation  of  the  tonsils,  disease  of  the  eye  and  ear,  and  disor- 
dered digestion. 

Treatment. — The  teeth  should  be  cleaned  with  a  toothbrush  at 
least  twice  a  day,  and  care  should  be  taken  that  all  particles  of  food 
are  removed.  Wooden  and  metal  toothpicks  should  not  be  used,  as 
the  gums  are  liable  to  be  injured,  which  may  be  followed  by  inflam- 
mation and  absorption  of  septic  products.  Quill  toothpicks  are  less 
objectionable,  but  should  be  employed  with  care.  When  brushing 
the  teeth,  a  small  quantity  of  tooth  powder  should  be  placed  upon 
the  brush.  The  formula  of  one  of  the  best  tooth  powders  is  as 
follows : 

Magnesium  peroxide 60  parts 

Sodium  perborate 30  pai-ta 

Powdered  castilo  soap  and  flavoring 10  parts 

When  a  tooth  powder  is  not  available  Castile  soap  can  be  used  for 
cleansing  the  teeth. 

Every  person  should  visit  the  dentist  at  least  twice  a  year  to  have 
his  teeth  examined,  cleaned,  and  necessary  repair  work  performed. 
A  dentist  should  also  be  consulted  whenever  there  is  toothache  or  a 
gumboil.  If  it  is  impossible  to  obtain  the  services  of  one,  temporary 
relief  from  toothache  can  be  obtained  by  cleaning  out  the  cavity  and 
putting  in  two  or  three  drops  of  oil  of  cloves  on  a  small  piece  of  cotton. 
For  toothache  without  the  presence  of  a  decayed  tooth  to  cause  it,  the 
application  of  heat  to  the  seat  of  the  pain  will  often  give  rehef . 

A  gumboil  should  be  opened  by  inserting  a  sharp-pointed  knife 
along  the  side  of  the  tooth  down  to  the  abscess  cavity  and  cutting 
forward  and  outward.  Before  doing  this  operation  the  mouth  should 
be  rinsed  out  mth  a  solution  containing  one  part  of  hydrogen  peroxide 
and  three  parts  of  water  or  some  other  antiseptic  wash.  The  knife 
should  be  boiled  before  it  is  used,  and  the  hands  of  the  operator  should 


MEDICAL    HANDBOOK.  13 

be  carefully  cleansed  with  soap  and  water  before  performing  the 
operation. 

The  treatment  for  Rigg's  disease  requires  that  the  tartar  and  yel- 
lowish matter  which  has  accumulated  along  the  edges  of  the  teeth 
and  between  the  teeth  be  removed  by  a  dentist,  who  should  be 
consulted  as  to  further  treatment. 

USE  OF  CLINICAL  THERMOMETER. 

Place  bulb  of  mercury  in  mouth  under  tongue  for  five  minutes.  If 
it  registers  over  101  degrees,  send  for  physician.  Stay  in  bed  until 
he  arrives.  See  that  it  registers  less  than  97  before  using.  This  may 
be  brought  about  by  shaking  it.  Grasp  the  thermometer  at  the 
middle  between  the  index  finger  and  the  thumb  of  the  right  hand, 
hold  the  bulb  downward  and  hit  the  lower  edge  of  the  right  hand 
against  the  upper  edge  of  the  left  hand;  the  column  of  mercury  will 
be  lowered  by  the  shock. 

MALARIAL  FEVER. 

Malarial  fever  is  an  endemic  infectious  disease,  caused  by  a  para- 
site of  the  blood.  The  disease  is  transmitted  to  man  (inoculated)  by 
the  bite  of  certain  Idnds  of  mosquitoes,  of  the  genus  Anopheles.  It  is  • 
never  found  except  where  mosquitoes  of  this  genus  are  present.  They 
breed  only  in  fresh  water.  Mosquitoes  that  breed  in  salt  or  brackish 
water  do  not  carry  disease. 

It  is  a  disease  of  warm  and  temperate  regions;  very  prevalent 
and  of  severe  type  in  hot  countries,  especially  along  the  seacoast 
and  basins  of  rivers,  but  gradually  declining  in  extent  and  virulence 
in  proportion  to  the  distance  on  either  side  from  the  Equator.  In 
the  Tropics  the  disease  is  constantly  prevalent.  In  the  cooler,  or 
temperate  regions,  as,  for  example,  along  the  coast  of  the  Central 
Atlantic  States,  it  is  active  only  during  summer  and  autumn.  It  is 
seldom  developed  at  a  lower  temperature  than  60°  F.  (15.5°  C), 
and  even  in  the  hot  cHmates  malaria  is  probably  never  contracted 
far  away  from  land.  The  disease  is  said  to  be  most  frequently  con- 
tracted during  the  night,  just  after  sunset  and  just  before  sunrise 
being  the  most  dangerous  periods.  It  is,  therefore,  very  important 
in  infected  localities  not  to  permit  the  men  to  go  ashore  nor  to  allow 
them  to  sleep  on  deck  if  the  vessel  is  lying  near  the  land;  or,  if  they 
must  sleep  on  deck  or  other  exposed  places,  to  provide  suitable  pro- 
tection by  means  of  blankets  and  properly  constructed  mosquito  bars. 

There  are  different  varieties  and  types  of  malarial  intermittent 
fever:  (1)  Quotidian,  when  the  paroxysm  occm-s  every  day;  (2) 
tertian,  when  it  occurs  every  other  day;  and  (3)  quartan,  when  it 
occurs  every  fourth  day.  The  disease  is  popularly  known  as  "fever 
and  ague,"  "cliills  and  fever,"  "the  shakes,"  etc.     It  is  characterized 


14  LIGHTHOUSE   SERVICE. 

by  recurring  paroxysms,  consisting  as  a  rule  of  three  distinct  stages: 
The  cold,  the  hot,  and  the  sweating  stage.  The  attack  may  be 
sudden  or  it  may  be  preceded  by  a  feeling  of  mieasiness,  a  desire  to 
stretch  the  Hmbs  and  yawn,  headache,  loss  of  appetite,  and  some- 
times by  vomiting.  The  chill  may  be  of  any  degree  of  severity. 
Patients  sometimes  complain  only  of  chilliness  or  of  a  creeping  sen- 
sation of  coldness  over  the  back.  More  frequently  the  chill  is  well 
marked;  the  feeling  of  cold  spreads  aU  over  the  body,  the  teeth 
chatter,  the  patient  shivers,  and  his  whole  body  shakes.  This  cold 
stage  may  last  from  a  few  minutes  to  an  hour,  or  longer. 

The  hot  stage  gradually  comes  on  as  the  cold  stage  subsides,  and 
soon  there  is  a  feeling  of  intense  heat.  The  face  becomes  flushed, 
the  pulse  fuU  or  bounding,  the  headache  continues,  and  the  patient 
is  in  high  fever.  This  stage  may  last  from  half  an  hour  to  4  or  5 
hours,  when  perepkation  appears,  fu'st  on  the  forehead  and  gradually 
over  the  entire  body,  and  the  sweating  stage  is  fuUy  estabhshed. 
With  the  appearance  of  perspiration  the  fever  declines,  the  distressing 
symptoms  gradually  cease,  the  patient  experiences  a  feehng  of  great 
rehef,  and  soon  falls  into  a  refreshing  sleep.  The  duration  of  the 
sweating  stage  varies  from  1  to  3  hours.  It  may  be  very  profuse  or 
very  slight.  At  the  end  of  the  sweating  stage  the  patient  may  be 
greatly  prostrated  or  may  feel  quite  well,  and  able  to  be  up  and  about 
until  the  beginning  of  the  cold  stage  of  the  next  fit,  24,  48,  or  72  hours 
from  the  beginning  of  the  first. 

There  are  three  varieties  of  malarial  fever — intermittent,  remit- 
tent, and  a  very  severe  type  known  as  pernicious  malarial  fever. 

In  the  intermittent  the  paroxysms  may  recur  at  irregular  intervals, 
the  cold  stage  may  be  absent,  the  fever  may  come  on  gradually  and 
decline  to  normal  in  the  same  manner. 

When  the  attacks  are  prolonged,  and  when  instead  of  declinmg  to 
normal  there  may  be  only  a  shght  fall  m  the  temperatiu-e  and  shght 
sweating,  the  fever  is  called  remittent  fever. 

Pernicious  malarial  fever,  as  the  name  indicates,  is  a  very  fatal 
disease.  It  occurs  chiefly  in  hot  chmates,  but  is  occasionally  met  with 
in  temperate  regions.  It  may  be  preceded  by  an  apparently  mild  at- 
tack of  intermittent  fever  or  the  patient  may  be  taken  suddenly  with 
intense  headache,  high  fever,  wild  or  perhaps  muttering  delirium, 
rapidly  passing  into  unconsciousness,  and  death  may  occur  within 
a  few  hours  from  the  beginning  of  the  attack. 

In  another  form  of  the  disease  the  attack  begins  with  extreme  cold- 
ness of  the  surface  of  the  body,  with  voniiting,  or  with  severe  diar- 
rhea or  dysentery,  and  the  patient  may  die  from  coUapse. 

There  is  also  a  hemorrhagic  form  ia  which  bleeding  may  occiu" 
from  the  nose,  mouth,  or  gums.  The  yrine  may  be  bloody  or  quite 
dark  in  color,  in  some  cases  almost  black.     In  tropical  Africa  and 


MEDICAL    HANDBOOK.  15 

other  hot  countries  where  the  disease  prevails  it  is  known  as  "black- 
water  fever." 

Hemorrhages,  however,  may  occur  in  any  severe  or  prolonged  form 
of  malarial  infection,  and  bloody  urine  (malarial  hematuria)  is  not 
infrec|uently  met  with. 

Treatment. — Qumine  is  the  remedy,  and  quinine  also  acts  as  a  pre- 
ventive. In  going  to  a  malarial  region,  treatment  should  be  com- 
menced several  days  before  arriving  at  port.  To  each  man  on  board 
should  be  given  at  least  10  gi'ains  (0.6  gm.)  of  quinine  daily  for  a 
period  of  one  week.  The  allowance  may  then  be  reduced  to  5  grains 
(0.3  gm.)  or  even  to  3  grams  (0.2  gm.)  a  day.  The  bowels  should 
be  kept  freely  open. 

The  measures  recommended  for  the  prevention  of  the  breeding  of 
mosquitos  on  page  10  should  be  strictly  carried  out  in  malarial  re- 
gions. Mosquitos,  unless  wind  blown,  do  not  travel  over  a  few 
hundred  yards  from  theu'  breeding  place.  If  malarial  fever  is  present, 
it  will  be  found  in  nearly  all  cases  that  they  are  breeding  in  some 
small  body  of  stagnant  water  immediately  around  the  house.  Such 
breeding  places  should  be  looked  for  and,  when  discovered,  abohshed. 
In  those  collections  of  water  which  can  not  be  eradicated,  1  ounce  of 
kerosene  added  from  time  to  time  to  every  15  square  feet  of  water 
will  prevent  the  growth  of  mosquitoes.  These  insects  shun  the  sun- 
light, and  during  the  clay  hide  in  grass  and  undergrowth.  Their 
numbers  may  be  greatly  diminished  by  cutting  away  the  bushes  in 
the  space  around  the  dwelling  and  by  keeping  the  grass  cut  short. 
It  is  important  that  the  bed  of  a  patient  suffering  from  malarial  fever 
should  be  protected  by  netting,  for  if  mosquitoes  are  allowed  to  bite 
him,  they  may  transmit  the  disease  to  other  members  of  the  house- 
hold. 

If  a  chill  occur,  the  patient  should  at  once  be  wrapped  in  blankets 
and  given  hot  drinks.  During  the  hot  stage,  cold  drinks,  lemonade, 
etc.,  may  be  given.  As  soon  as  the  sweating  stage  begins,  10  or  15 
grains  (0.6  gm.  to  1  gm.)  of  ciuinine  should  be  given,  and  thereafter  5 
grains  (0.3  gm.)  every  six  hours,  for  two  or  three  days,  and  then  con- 
tinued in  smaller  doses,  say  3  grains  (0.2  gm.)  three  times  daily,  for 
the  next  two  weeks. 

If  the  chill  is  severe,  or  if  the  surface  of  the  body  is  very  cold,  hot- 
water  bottles  or  heated  bricks  or  stones  wrapped  in  cloth  or  in  a 
separate  piece  of  blanket  should  be  placed  to  the  feet.  Mustard 
plasters  may  also  be  apphed  to  the  extremities  and  over  the  region 
of  the  heart,  and  hot,  stimulating  drinks  should  be  given. 

If  vomiting  occur,  a  mustard  plaster  may  be  placed  over  the 
region  of  the  stomach,  above  the  navel,  and  cracked  ice  may  be  given 
by  the  mouth.  Headache  may  be  relieved  by  cold  apphcations  or 
by  10  grains  of  aspirin  taken  with  a  cup  of  hot  tea. 


16  LIGHTHOUSE   SERVICE. 

If  the  hot  stage  is  severe,  a  tepid  bath  may  be  given  in  a  tub  or  by- 
means  of  a  sponge.  If  the  temperature  is  very  high,  105°  or  106°  F. 
(40.5°  or  41.1°  C),  a  cold  bath  should  be  given. 

In  remittent  and  other  severe  types  of  malarial  fever  the  treatment 
should  be  more  active.  No  time  should  be  lost  in  giving  the  qumine; 
10  or  15  or  20  grains  (0.6  gm.  to  1.3  gm.)  should  be  given  imme- 
diately, and  along  with  this,  if  the  bowels  are  not  freely  open,  a  calo- 
mel tablet,  one-tenth  grain  each,  should  be  given  every  half  hour  until 
10  have  been  taken.  After  the  bowels  move  the  quinine  should  be 
continued,  in  5-grain  (0.3  gm.)  doses  every  four  or  five  hours. 

The  symptoms  and  signs  of  typical  malarial  intermittent  fever  are 
so  striking  that  they  can  hardly  be  mistaken  for  anything  else.  It 
must  not  be  forgotten,  however,  that  there  are  atypical  and  irregular 
forms  of  malarial  fever,  and  that  they  may  be  mistaken  for  other 
diseases,  such  as  tubercle  (consumption)  of  the  lungs,  abscess  of  the 
lungs  or  of  the  liver  or  any  part  of  the  body,  or  the  result  of  the 
passing  of  a  catheter,  all  of  which  produce  chills  or  chilliness  and 
fever. 

Some  forms  of  remittent  or  continued  remittent  malarial  fever 
may  be  difficult  to  distinguish  from  typhoid  fever.  The  remittent 
type  may  be  mistaken  for  yellow  fever. 

Quinine  is  the  remedy  for  any  form  of  malarial  fever.  If  the 
fever  does  not  yield  to  full  doses  of  quinine,  it  is  probably  not  mala- 
rial. At  any  rate  this  is  the  most  practical  method  for  determining 
the  question  as  to  whether  the  fever  is  malarial  or  not.  In  the  hos- 
pital or  laboratory  the  diagnosis  is  made  by  microscopical  examina- 
tion of  the  blood. 

The  diet  in  any  form  of  acute  fever  should  be  light,  liquid,  and 
nourishing;  and  if  there  is  much  prostration,  stimulants  wiU  be  re- 
quired.    Solid  food  sliould  not  be  allowed. 

MEASLES. 

Measles  is  an  acute  infectious  disease,  which  most  commonly  at- 
tacks children  but  may  occur  in  adults.  It  usua-Uy  spreads  from  per- 
son to  person  by  exposure  to  a  patient  with  the  disease,  as  going  into 
the  room  where  he  is  sick,  riding  in  tlie  same  street  car,  or  being  in 
the  same  schoolroom.  It  generally  makes  its  appearance  from  twelve 
to  fourteen  days  after  exposure.  One  attack  is  nearly  always  a  pro- 
tection against  a  second  one. 

It  begins  with  the  symptoms  of  an  ordinary  cold.  There  may 
be  an  initial  chiU;  the  patient's  face  looks  flushed  and  sometimes 
slightly  swollen  about  the  nose  and  eyes,  and  the  eyes  are  red- 
dened. There  may  be  a  tendency  to  sneeze,  and  an  examination  of 
the  throat  wUl  disclose  a  reddening  of  the  mucous  membrane.  The 
rash  often  appears  first  in  the  throat.     Some  cough  may  be  present 


MEDICAL   HANDBOOK.  17 

at  the  onset,  with  more  or  less  headache.  Fever  is  present  with 
the  onset  of  these  symptoms.  The  eruption  on  the  skin  devel- 
ops on  the  third  or  fourth  day  of  the  fever.  It  may  be  most  marked 
on  the  forehead  or  about  the  ears,  looking  like  fieabites,  and  gradu- 
ally spreads  over  the  entire  body.  The  patient  has  considerable 
cough  with  expectoration.  In  children  there  is  some  liability  to  a 
form  of  pneumonia  called  broncho-pneumonia,  which  renders  the 
disease  much  more  dangerous.  It  may  also  have  the  complication  of 
diarrhea  and  vomiting,  due  to  implication  of  the  bowels  and  stomach. 

As  soon  as  a  case  is  discovered  it  should  be  put  in  bed  and  isolated 
in  a  room,  from  which  children  should  be  excluded  and  only  those 
adults  admitted  who  are  dhectly  concerned  in  the  care  of  the  case. 

It  is  necessary  to  protect  the  patient  from  becoming  chilled,  and 
he  should  not  be  exposed  to  drafts,  but  fresh  air  should  be  admitted 
to  the  room.  If  the  weather  is  cold,  he  should  be  provided  with 
plenty  of  covering. 

The  treatment  of  an  ordinary  case  of  measles  is  practically  nil,  as 
little  or  no  medication  is  required.  If  there  is  much  irritation  of  the 
eyes,  it  is  well  to  have  the  room  darkened  and  to  wash  out  the  eyes 
with  a  saturated  solution  of  boric  acid  in  warm  water.  Take  a  glass 
of  warm  water  and  put  into  it  all  the  boric  acid  it  will  dissolve  and 
use  it  as  a  wash  for  the  eyes,  keeping  it  covered  to  prevent  dust  or 
other  impurities  getting  into  the  solution.  Everything  applied  to 
the  eyes  should  be  scrupulously  clean. 

If  the  skin  is  dusky  and  the  eruption  is  not  weU  marked,  the  pa- 
tient maybe  enveloped  in  sheets  or  blankets  wrung  from  hot  water, 
but  care  must  be  exercised  that  he  does  not  become  too  rapidly  chilled 
afterwards.  Only  sufficient  covering  should  be  used  to  render  the 
patient  comfortable. 

If  the  cough  is  very  troublesome,  a  tablet  of  Brown  Mixture  may 
be  given  every  two  hours. 

After  the  eruption  has  disappeared  and  the  peeling  of  the  skin  has 
begun,  the  patient  should  bathe  daily  in  order  that  the  skin  may  be 
freed  from  the  scales. 

During  the  period  of  the  disease  the  patient  may  be  fed  on  broths, 
milk,  soft-boiled  eggs,  etc. 

Disinfection  is  not  now  considered  necessary  after  measles,  as  it  is 
believed  the  disease  is  transmitted  only  by  contact  with  a  sick  per- 
son and  experiments  show  there  is  httle  danger  of  contracting  the 
disease  after  the  eruption  appears.  If  it  is  desired  to  disinfect  the 
room  after  the  patient  recovers,  the  following  procedure  should  be 
carried  out: 

The  bedclothes  should  be  boiled  20  mmutes  or  soaked  in  a  3  per  cent 
solution  of  carbohc  acid  for  one  hour.     All  the  openings  in  the  room 

9S90S°— 15 2 


18  LIGHTHOUSE   SERVICE. 

should  be  closed,  and  it  should  be  fumigated  with  formaldehyde  gas  by 
placing  formalin  in  a  10-quart  pail  and  pouring  permanganate  of  pot- 
ash onto  it.  One  pint  of  formalin  and  one-half  pound  of  potash 
should  be  employed  for  every  1,000  cubic  feet  of  air  space.  The 
time  of  exposure  should  be  4  hours,  after  which  the  doors  and  win- 
dows should  be  opened  and  the  gas  allowed  to  blow  out.  The  room 
should  then  be  thoroughly  cleaned  and  aired  for  several  days.  Mat- 
tress, curtains,  rugs,  and  carpet  should  be  taken  out  of  the  room  after 
fumigation,  hung  out  in  the  smishine,  and  be  well  beaten  before 

being  used  again. 

SMALLPOX. 

Smallpox  is  an  acute,  contagious  disease,  characterized  by  an  initial 
fever  and  successive  stages  of  eruption.  It  spreads  rapidly  among 
persons  unprotected  by  vaccination.  It  may  be  communicated  by  the 
breath,  by  exhalations  from  the  skhi,  by  clothing,  or  by  anything  that 
has  been  in  contact  with  a  person  suffering  from  the  disease.  It  is 
very  contagious  during  the  latter  stage  of  eruption,  and  especially 
during  the  period  of  convalescence  when  the  dried  pus  scales  become 
detached  from  the  skin  and  in  the  form  of  dry  powder  or  dust  settle 
on  everything  about  the  room  or  compartment,  and  may  be  conveyed 
not  only  to  aU  parts  of  the  ship  or  hght  station,  but  to  any  part  of 
the  world  to  which  the  ship  is  bound. 

After  a  period  of  incubation  of  from  8  to  14  days,  occasionally 
longer,  the  disease  begins  suddenly,  usually  with  a  chiU,  always  with 
severe  pain  in  the  back  and  loins,  intense  headache,  and  high  fever. 
Vomiting  occurs  in  many  cases.  The  bowels  may  or  may  not  be 
constipated. 

About  the  end  of  the  third  day  or  on  the  fourth  day  a  papular 
eruption  appears  on  the  forehead,  and  frequently  on  the  Hps  and  the 
wrists,  occasionally  in  the  mouth  and  throat,  and  gradually  extends 
to  other  parts  of  the  body.  The  eruption  begins  as  a  bright  red  dot 
or  spot  shghtly  elevated  above  the  surrounding  skin,  enlarging  until 
the  second  day,  when  it  forms  a  papule.  The  papule  is  hard  to  the 
touch,  feels  hke  shot  imder  the  skin.  As  soon  as  the  eruption  appears 
the  temperature  begins  to  fall,  and  the  distressing  symptoms  subside. 
On  the  fifth  or  sixth  day  a  small  vesicle,  with  a  depression  of  the 
center,  appears  on  the  top  of  the  papule.  The  vesicles  gradually 
become  distended,  the  depressed  centers  rounded  out,  and  about  the 
eighth  or  ninth  day  the  change  is  completed  and  the  vesicles  become 
pustules.  They  have  a  yellowish  gray  appearance  and  each  pustule 
is  surrounded  by  a  red  border.  The  skin  between  them  is  swollen, 
the  eyes  may  be  closed.  During  this  change  the  temperature  rises 
again,  secondary  fever  sets  in,  the  chief  symptoms  return,  and  a  day 
or  two  later  another  change  begins.  The  pustules  break,  matter  oozes 
out,  crusts  form,  first  on  the  face  and  then  over  other  parts  of  the 


MEDICAL   HANDBOOK.  19 

body,  following  the  order  of  the  appearance  of  the  eruption.  The 
secondary  fever  may  be  quite  high  in  the  beginning,  but  gradually 
declines  as  the  pustules  change  into  crusts,  and  in  favorable  cases 
seldom  lasts  more  than  two  or  three  days.  The  crusts  then  rapidly 
dry  and  fall  off,  leaving  red  spots  on  the  skm  and  here  and  there  the 
characteristic  pockmarks  or  pits.  The  healing  of  the  pustules  is 
usually  attended  by  troublesome  itching. 

In  some  cases  a  diffuse  redness  of  the  skin  or  red  spots  appear  on 
the  abdomen,  or  on  the  side  of  the  chest,  or  on  the  inner  surface  of 
the  thighs  as  early  as  the  second  day,  but  the  distinctive  papular 
eruption  makes  its  appearance,  as  stated,  at  the  end  of  the  third  or 
on  the  fourth  day  and  nearly  always  begins  on  the  forehead. 

In  the  confluent  form  of  smallpox  the  eruption  may  appear  a  day 
earher  and  aU  the  symptoms  are  more  severe.  The  pustules  run 
together  and  form  large  brownish  scabs,  chiefly  on  the  face  and  head, 
but  also  on  the  hands  and  feet.  The  face  and  neck  are  greatly  swol- 
len, the  eyes  are  closed,  the  features  are  distorted.  The  patient  com- 
plains of  tension  and  burning  of  the  skin;  there  is  much  thirst.  The 
eruption  may  also  appear  in  the  mouth  and  throat.  The  secondary 
fever  is  high.  Delirium  may  be  quite  marked.  In  fatal  cases  the 
pulse  becomes  rapid  and  feeble,  and  death  occurs  about  the  tenth  or 
eleventh  day  or  later. 

In  favorable  cases,  about  the  eleventh  or  twelfth  day  the  pustules 
begin  to  break.  The  matter  dries  and  forms  crusts  which  slowly  fall 
off,  leaving  the  skin  quite  red  and  in  many  cases  dreadfully  scarred 
and  pitted. 

The  crusts  begin  to  drop  off  about  the  fourteenth  day,  but  the  pro- 
cess of  desquamation  may  not  be  completed  until  the  end  of  the  third 
or  fourth  week,  and  the  fever  may  persist  during  that  preiod.  There 
is  a  milder  form  of  smallpox  called  varioloid,  in  which  the  symptoms 
are  usually  milder  and  of  shorter  duration.  Varioloid  occurs  in  per- 
sons who  have  been  vaccinated.  Sometimes  the  eruption  begins  on  the 
feet.  In  some  cases  it  is  confined  to  the  feet  and  hands.  Occasionally 
the  eruption  is  extensive  and  the  symptoms  are  severe. 

The  most  severe  type  of  smallpox  is  the  hemorrhagic  (bloody).  It 
occurs  in  two  forms.  In  one  the  case  goes  on  in  the  usual  way  until 
about  the  nmth  or  tenth  day,  when  blood  makes  its  appearance  in  the 
pock.  This  form  is  sometimes  called  black  smallpox.  In  the  other 
form  the  eruption  may  be  blood-colored  from  the  second  day,  and 
bleeding  may  take  place  from  the  nose  or  mouth  or  from  the  rectum. 
The  face  is  greatly  swoUen  and  the  eyes  are  deeply  bloodshot.  Death 
occurs  during  the  first  week,  sometimes  as  early  as  the  second  day. 

Before  the  characteristic  eruption  appears  it  is  frequently  very 
difficult  to  determine  the  existence  of  smallpox.  It  is  easily  con- 
founded with   other  eruptive   diseases.     The  important  pomts   to 


20  LIGHTHOUSE    SERVICE. 

remember  are  the  intense  pain  in  the  back,  the  liigh  fever,  and 
bomiding  pulse,  all  of  which  precede  the  eruption,  and  that  when 
the  eruption  appears  the  fever  and  aU  the  severe  symptoms  subside. 
The  temperatin-e  before  the  eruption  may  be  up  to  105°  or  106°  F. 
(40.5°  or  41.1°  C).  When  the  eruption  appears  it  begins  to  decline 
and  within  24  or  36  hours  is  down  to  about  100°  F.  (37.7°  C).  When 
the  secondary  fever  sets  in  the  temperature  rises  again. 

Treatment. — The  patient  should  be  placed  in  a  cool,  weU-ventilated 
room,  and  strictly  isolated;  and  every  person  at  the  hght  station  or 
on  board  the  ship  should  be  immediately  vaccinated.  No  one  should 
be  allowed  to  come  in  contact  with  him  except  the  nurse  or  attendant, 
and  the  nurse  or  attendant  should  not  be  allowed  to  come  in  contact 
with  other  persons.  While  in  immediate  attendance  on  the  sick  he 
should  wear  overalls  and  jumper,  and  a  head  covering,  to  be  removed 
when  he  leaves  the  room,  and  immediately  put  on  again  when  he 
returns.  Separate  dishes  and  necessary  utensils  should  be  provided. 
The  food  should  be  placed  at  a  convenient  place  near  the  door  of  the 
sick  room  where  the  nurse  can  come  and  get  it.  Nothing  should  be 
allowed  in  the  room  except  the  articles  absolutely  necessary.  The 
soiled  clothing  should  be  wrapped  in  a  clean  sheet  (or  in  a  sheet  that 
has  been  dipped  in  a  1  to  1,000  solution  of  bichloride  of  mercury) 
and  the  bundle  placed  in  a  kettle  of  water  and  thoroughly  boiled. 
If  there  is  a  sufficient  supply  of  bedclothing  the  soiled  articles  should 
be  destroyed  by  fire  (burned).  The  patient  must  be  kept  thoroughly 
clean.     Good  nursing  is  very  important. 

In  the  early  stage,  when  the  fever  is  high,  place  the  patient  in  a 
cold  bath,  or  give  him  a  cold  sponge  bath,  note  the  temperature  of  the 
body,  and  repeat  the  bath  every  three  hours  if  the  thermometer  regis- 
ters above  103°  F.  (39.4°  C).  If  the  bowels  are  constipated,  give 
small  doses  of  Epsom  salts,  2  teaspoonfuls,  every  two  or  three  hours. 

The  food  should  be  soft  and  nourishing  and  given  at  regular  inter- 
vals. Cold  drmks,  lemonade,  barley  water,  etc.,  may  be  freely  given. 
Asperm,  10  grains  may  be  given  for  the  headache. 

The  pain  and  tension  in  the  skin  maybe  reheved  by  cold  apphcations. 
A  piece  of  lint,  wet  with  a  cold  one-half  of  1  per  cent  solution  of  carbohc 
acid,  may  be  apphed  to  the  face  and  frequently  renewed.  Holes 
should  be  cut  into  the  lint  corresponding  to  the  eyes,  nose,  and  mouth. 
When  the  pustules  begin  to  form  it  is  a  good  plan  to  touch  each  one 
with  tincture  of  iodine  (a  camel' s-hair  brush  may  be  used  for  the 
purpose),  and  a  day  later  to  puncture  them  with  the  point  of  a  needle. 
The  needle  should  first  be  boiled,  and  the  point  should  then  be  dipped 
in  tincture  of  iodine  before  making  the  puncture.  When  crusts  begin 
to  form,  ohve  oil  or  glycerin  should  be  apphed.     If  the  hair  is  long 


MEDICAL  HANDBOOK.  21 

it  shotdd  be  cut  short  early  in  the  disease  before  the  pustular  stage 
begms.  The  eyes  must  be  carefully  cleansed  several  times  a  day,  else 
blindness  may  follow.  A  solution  of  boric  acid,  5  grains  to  a  fluid 
ounce  of  water,  is  a  good  eyewash.  The  mouth,  throat,  and  nose  also 
require  attention.  A  saturated  solution  of  boric  acid  may  be  used 
as  a  mouth  wash  and  gargle. 

When  the  crusts  and  scabs  drop  off  they  should  be  carefully  gath- 
ered up  and  burned.  The  patient  should  then  have  a  daily  bath,  with 
soap  and  water.  When  the  case  is  ended  the  room  and  aU  exposed 
articles  must  be  disinfected  by  burning  sulphur  (4  pounds  to  every 
1,000  cubic  feet  of  air  space). 

On  shipboard,  if  near  port  when  the  disease  breaks  out,  the  ship 
should  be  taken  direct  to  the  quarantine  station,  where  the  patient 
may  be  taken  care  of  and  the  ship  disinfected. 

Vaccination. — This  procedure  prevents  smallpox.  Every  child 
should  be  vaccinated  before  it  is  6  months  old,  and  again  when  it 
reaches  school  age.  If  the  vaccination  does  not  take,  the  operation 
should  be  repeated  until  it  is  successful.  A  small  papule  should 
appear  in  48  hours,  which  soon  changes  into  a  vesicle.  This  gradu- 
ally enlarges,  until  at  the  end  of  one  week  it  is  the  size  of  a  finger  nail. 
It  is  then  of  a  whitish  color  and  is  surrounded  by  a  reddish  area.  At 
this  time  the  patient  may  have  a  sHght  fever,  headache,  or  some 
disturbance  of  digestion.  On  the  tenth  or  thirteenth  day  these 
symptoms  have  usually  subsided,  the  vesicle  begins  to  dry  up,  forming 
a  scab,  and  the  redness  of  the  surroundmg  area  diminishes  and 
finally  disappears.  If  the  vaccination  is  kept  clean  by  frequent 
washing  with  boUed  water,  and  irritating  substances,  such  as  woolen 
shirts  or  coats,  are  not  allowed  to  touch  it,  there  is  little  danger  of 
harmful  germs  gaining  entrance  through  the  wound.  Some  physi- 
cians advise  the  use  of  celluloid  shields,  but  these  exclude  the  air 
and  are  hot  and  uncomfortable.  If  care  is  taken  not  to  break  the 
vesicle,  dressing  is  usually  unnecessary;  but  if  a  dressing  must  be 
employed,  the  simpler  the  better.  A  little  sterile  vaseline  or  boracic- 
acid  ointment,  spread  upon  a  piece  of  clean  linen,  generally  suffices. 
This  should  extend  beyond  the  inflamed  area  and  be  held  in  place  by 
strips  of  narrow  adhesive  plaster. 

If  a  person  has  not  been  vaccinated  durmg  childhood,  he  should 
have  this  operation  performed  immediately  in  order  to  protect  him- 
self from  smallpox.  No  one  can  teU  when  he  might  come  in  contact 
with  this  disease,  and  if  not  protected  by  vaccination  he  is  extremely 
liable  to  contract  it.  After  an  interval  of  about  seven  years  a  second 
vaccination  should  be  performed,  and  this  also  should  be  repeated 
until  successful.  Smallpox  has  been  practicaUy  ehminated  from 
some  countries  by  vaccination. 


22  LIGHTHOUSE   SERVICE. 

SCARLET  FEVER. 

Scarlet  fever  is  a  comniiinicable  disease  characterized  by  fever, 
sore  throat,  and  a  red  rash.  When  the  disease  is  mild  it  is  called 
scarlatina  or  scarlet  rash.  The  incubation  period  is  from  two  to  four 
days.  It  begms  with  headache,  vomitmg,  faintness,  and  occasionally 
convulsions  in  children.  The  mouth  and  throat  are  deeply  congested. 
There  is  pain  on  swallowing  or  talking.  The  tongue  has  the  color 
of  a  ripe  strawberry.  The  inflammation  may  extend  from  the  throat 
to  the  ears.  The  glands  of  the  neck  often  become  swollen.  The 
rash  appears  on  the  second  day  of  the  disease,  and  in  mild  cases  may 
be  the  first  symptom  noticed.  It  occurs  as  a  diffuse  redness,  which, 
upon  close  observation,  wOl  be  found  to  be  due  to  fine  red  papules. 
After  four  or  five  days  the  skin  commences  to  shed.  Sometimes  it 
is  cast  off  m  large  flakes. 

Complications. — Inflammation  of  many  organs  of  the  body  may 
follow  scarlet  fever.  There  may  be  pneumonia,  pleurisy,  ulceration 
of  the  throat,  abscesses  in  the  neck,  and  inflammation  of  the  lining 
membrane  of  the  heart.  Nephritis  or  inflammation  of  the  kidneys 
frequently  occurs  from  the  second  to  the  fourth  week.  In  this  com- 
plication there  is  diminution  or  suppression  of  urine,  with  pufhness 
under  the  eyes,  sweUing  of  the  hands  and  ankles,  or  general  dropsy. 
There  may  be  convulsions  and  the  case  may  quickly  terminate 
fatally.  In  other  cases  the  secretion  of  urine  is  reestablished  and 
the  person  either  entirely  recovers  or  the  disease  persists  in  a  chronic 
form.  There  may  be  pain,  swelling,  and  redness  of  the  joints. 
Careful  watch  should  be  kept  for  symptoms  of  inflammation  of  the 
middle  ear.  These  are  pain  in  the  ear,  tenderness  over  the  bony 
prominence  behind  the  ear,  and  drowsiness.  The  child  may  moan 
in  its  sleep  and  be  hard  to  arouse.  If  the  drum  membrane  breaks, 
the  pent-up  pus  escapes  from  the  ear  opening,  and  if  the  inflamma- 
tion is  mild,  the  symptoms  then  abate;  otherwise  an  abscess  forms  in 
the  bony  cells  behhid  the  ear  which  if  not  opened  may  break  into  the 
cranial  cavity  or  spread  downward  along  the  deep  tissues  of  the 
neck. 

Varieties. — ^Mild  cases  may  not  be  recognized  until  some  unusual 
occurrence,  such  as  a  swelling  in  the  neck,  the  shedding  of  skin,  the 
onset  of  nephritis,  or  illness  in  another  child  who  has  been  in  com- 
pany with  the  patient,  calls  attention  to  the  fact  that  the  child  has 
had  an  attack  of  scarlet  fever.  The  rash  may  be  absent  or  present 
on  only  a  portion  of  the  body.  The  mild  form  may  give  rise  to  a 
severe  attack  in  another  person.  In  a  mahgnant  case  there  may  be 
high  fever,  dehrium,  coma,  gangrene  of  the  throat  with  a  foul  dis- 
charge from  the  nose  and  mouth,  the  patient  dying  in  one  or  two 
days. 


MEDICAL   HANDBOOK.  23 

Death  is  rare  in  cases  that  receive  proper  care  and  attention, 
although  many  persons  succumb  to  the  comphcations  produced  by- 
scarlet  fever,  and  it  is  often  the  starting  point  of  chronic  disease  of 
the  heart,  ears,  or  kidneys  which  cause  death  in  after  life.  It  is 
more  fatal  to  children  less  than  6  years  old. 

Treatment. — Isolate  the  patient.  Keep  the  room  warm,  with  a 
window  partly  open  for  ventilation.  Put  the  patient  in  bed,  but 
do  not  cover  him  up  with  too  much  bed  clothing.  If  the  child  has 
convulsions,  give  him  a  hot  bath;  if  the  fever  is  high,  sponge  him  off 
with  cold  water.  If  there  is  vomiting,  apply  a  small  mustard  plaster 
over  the  upper  part  of  the  stomach,  and  give  him  a  cup  of  hot  water 
in  which  has  been  placed  a  teaspoonful  of  sodium  bicarbonate.  If 
there  is  severe  headache,  give  10  grains  of  aspirin  if  the  patient  is  an 
adult;  if  a  chdd,  give  3  to  5  grains.  Cold  compresses  should  be  ap- 
plied to  the  neck.  The  mouth  should  be  frequently  rinsed  with  a 
saturated  solution  of  boracic  acid,  and  the  throat  kept  clean  by 
gargling  with  a  solution  composed  of  peroxide  of  hydrogen  one  part, 
water  two  parts.  This  solution  may  also  be  applied  with  a  swab 
made  by  tying  a  small  piece  of  cotton  onto  a  smaU  stick.  If  no 
peroxide  of  hydrogen  is  obtainable,  a  salt  solution  made  by  placing  a 
teaspoonful  of  salt  to  a  pint  of  water  may  be  employed  in  its  place. 
One  tablet  of  calomel,  each  one-half  of  a  grain,  should  be  given 
every  half  hour  until  four  are  taken.  This  should  be  followed  in  four  or 
five  hours  by  a  Seidlitz  powder  or  a  dose  of  salts.  If  there  is  earache, 
hot  compresses  should  be  applied  to  the  side  of  the  head  and  ear  drops 
(acidi  carbolici,  1  fluid  drachm,  glycerin  7  fluid  drachms,  mixed  well 
together)  should  be  placed  in  the  ear.  If  possible,  a  physician  should 
be  immediately  called;  if  the  drum  membrane  is  opened  early,  the 
hearing  of  the  patient  may  often  be  preserved. 

The  patient  should  have  a  light  diet  with  plenty  of  water  to  drink, 
especially  if  there  is  any  sign  of  dropsy.  If  this  develops,  hot  com- 
presses should  be  applied  to  the  back,  and  hot  water  (temperature 
from  110°  to  120°  F.)  should  be  injected  slowly  into  the  bowels,  several 
quarts  at  the  time.  If  the  excretion  of  urine  is  greatly  diminished, 
it  may  be  necessary  to  put  the  patient  into  a  hot  pack.  This  is  done 
by  wringing  out  a  sheet  in  hot  water  and  immediately  wrapping  the 
patient  in  it,  and  covering  him  with  blankets.  If  there  is  electricity 
on  the  vessel  or  station,  the  patient  may  be  made  to  sweat  by  placing 
several  light  bulbs,  connected  with  lamp  socket,  between  the  blankets 
on  the  patient's  bed  and  turning  on  the  light.  The  patient  should 
not  be  considered  well  until  the  skin  has  ceased  pealing  and  all  dis- 
charge of  pus  has  ceased.  He  may  then  be  allowed  to  mix  with 
other  persons.  The  room  and  its  contents  should  be  disinfected,  as 
directed  under  "Measles," 


24  LIGHTHOUSE   SEKVICE. 

DIPHTHERIA. 

Diphtheria  is  a  communicable  disease,  due  to  the  action  of  the 
bacillus  diphtherige.  When  conditions  are  favorable,  this  germ 
causes  an  inflammation  of  the  lining  membrane  of  the  throat,  upon 
which  a  grayish  fibrinous  exudate  forms.  The  constitutional  symp- 
toms of  the  disease  are  the  result  of  the  absorption  into  the  circula- 
tion of  toxins  or  poisons  produced  at  the  site  of  the  lesion.  The 
grayish  exudate  is  usually  on  the  tonsils  and  palate,  but  it  may  ex- 
tend up  into  the  nose  or  down  into  the  windpipe.  A  raw  bleeding 
surface  is  left  when  a  portion  of  this  exudate  or  false  membrane  is 
detached.  Efforts  at  swallowing  cause  strangulation  or  choking, 
and  the  patient  may  become  asphyxiated  by  the  exudate  membrane 
blocking  up  the  larynx.  The  voice  is  often  husky,  and  there  may  be 
a  rough  cough  to  which  the  term  ''croupy"  has  been  appHed.  In 
severe  cases  there  is  high  fever  and  great  prostration. 

Sequelae. — Paralysis  may  foUow  diphtheria.  This  may  be  slight, 
only  affecting  the  palate,  giving  the  voice  a  nasal  character;  or  severe, 
nearly  all  the  muscles  of  the  body  being  involved.  Weakness  of  the 
heart  sometimes  causes  death  as  late  as  the  sixth  or  seventh  week. 
Nephritis  may  be  one  of  the  complications  of  the  disease,  but  dropsy 
is  less  common  than  after  scarlet  fever. 

Diagnosis. — Whenever  a  grayish  exudate  is  seen  on  the  throat, 
diphtheria  should  be  suspected,  especially  if  much  inflammation  is 
present  and  if  bleeding  occurs  when  a  piece  of  the  false  membrane  is 
detached.  Diphtheria  examination  packages  are  now  supplied  free 
by  most  drug  stores.  These  packages  hold  two  glass  tubes,  one  of 
which  contains  blood  serum  and  the  other  a  sterile  swab.  The  tubes, 
are  closed  by  cotton  plugs.  These  should  be  removed,  the  swab  wiped 
over  the  throat,  and  then  gently  rubbed  over  the  blood  serum.  The 
swab  should  then  be  replaced  into  its  own  tube,  the  cotton  plugs  of 
both  tubes  replaced,  and  the  tubes  mailed  to  the  health  officer  of  the 
city  or  district.  A  postal  card  will  be  mailed  by  him  the  next  day 
to  the  sender  stating  whether  or  not  the  person  from  whom  the 
specimen  was  taken  has  diphtheria. 

Treatment. — As  soon  as  it  is  suspected  that  a  person  has  diphtheria 
a  physician  should  be  sent  for,  if  possible,  as  it  is  important  that 
diphtheria  antitoxin  should  be  at  once  administered  to  the  patient. 
If  this  serum  is  given  in  sufficient  quantities  (5,000  to  10,000  units) 
early  in  the  disease,  the  symptoms  disappear  like  magic.  The  fever 
subsides,  the  inflammation  in  the  throat  abates,  the  exudate  is  cast 
off,  and  the  tissues  heal  promptly.  The  dose  of  antitoxin  should  be 
repeated  in  a  few  hours  if  the  fever  contmues.  Some  cases,  where  the 
disease  has  remained  untreated  for  several  days,  require  large  quan- 
tities of  antitoxin  (80,000  to  90,000  units).     Where  antitoxin  can  not 


MEDICAL   HANDBOOK.  25 

be  obtained,  the  patient  should  be  given  stimulants,  cold  compresses 
should  be  applied  to  the  neck,  and  the  throat  should  be  frequently 
swabbed  with  the  following  solution:  Carbolic  acid,  3  parts;  water 
sufficient  to  make  100  parts.  Calomel  grains,  one-fourth,  every  two 
hours,  is  recommended  by  some  physicians,  but  care  has  to  be  taken 
that  the  patient  does  not  become  salivated.  The  room  should  be 
warm,  a  window  should  be  partly  open  for  ventilation,  and  the  air 
should  be  kept  moist  by  placing  a  hood  made  with  a  sheet  over  the 
bed  and  allowing  the  steam  from  a  kettle  to  pass  under  it.  A  licjuid 
diet  should  be  given,  and  if  it  is  impossible  for  the  patient  to  swallow 
he  has  to  be  fed  by  the  rectum.  If  there  is  obstruction  of  the  larynx 
and  the  patient  is  blue  in  the  face,  intubation  or  tracheotomy  has  to 
be  performed.  In  the  first  operation  a  special  hollow  tube  with  a 
thi'ead  attached  is  inserted  in  the  larynx,  being  guided  m  place  by 
the  finger.  If  no  intubation  tube  is  available,  recourse  has  to  be  had 
to  tracheotomy.  The  physician  grasps  the  windpipe  between  the 
forefinger  and  thumb  of  the  left  hand,  pushes  the  other  tissues  of  the 
neck  to  each  side,  and  opens  the  windpipe  m  the  middle  Ime.  This 
operation  requires  some  skill,  and  should  not  be  performed  except  as 
a  last  resort.  The  patient  should  not  be  allowed  to  mingle  with 
other  persons  until  a  culture  has  been  taken,  as  described  under 
''Diagnosis,"  and  sent  to  the  city  or  State  department  of  health  and 
found  to  be  negative;  that  is,  no  germs  of  diphtheria  present.  The 
room  and  its  contents  should  then  be  disinfected,  as  described  under 
the  heading  ''Measles." 

SORE  THROAT  (TONSILLITIS,  QUINSY). 

Sore  throat  is  a  conunon  disease.  It  is  usually  the  result  of  expo- 
sure to  wet  and  cold.  Talking,  laughing,  or  shouting  in  a  damp, 
cold  atmosphere  is  sometimes  the  cause  of  it.  It  frequently  occurs 
in  persons  predisposed  to  rheumatism.  It  may  accompany  or  be 
an  extension  from  an  ordinary  "cold  in  the  head."  Sometimes 
the  inflammation  is  limited  to  the  mucous  membrane  of  the  pharynx 
and  soft  palate;  it  is  then  known  as  pharyngitis  or  acute  catarrhal 
sore  throat.  More  frequently  the  tonsils  are  affected,  and  the  inflam- 
mation is  then  called  tonsillitis.  When  the  inflammation  is  more 
deeply  seated  behind  the  tonsil  and  tends  to  suppurate  or  form  an 
abscess,  the  term  quinsy  is  apphed.  An  attack  of  sore  throat  may 
last  from  2  to  10  days,  or  longer. 

Symptoms  of  acute  sore  throat  are  chilliness  and  feverishness, 
pain  or  soreness  on  swallowing,  dryness,  or  a  tickling  or  scratchmg 
sensation  in  the  throat. 

There  is  apt  to  be  a  stiffness  and  some  tenderness  along  the  side  of 
the  neck.     If  one  or  both  tonsils  are  involved,  as  they  usually  are 


26  LIGHTHOUSE   SERVICE. 

to  a  greater  or  less  extent,  the  symptoms  are  more  severe.  In  marked 
cases  examination  shows  redness  and  swelUng  of  the  parts  affected — 
swollen  tonsils  (tonsillitis)  and  white  or  cream-colored  spots  may  be 
seen  on  the  surface  of  one  or  both  tonsils.  (This  form  of  the  disease 
is  frequently  mistaken  for  diphtheria.)  There  may  be  high  fever 
and  great  prostration. 

In  the  severest  form  of  tonsillitis  (quinsy)  the  tonsil  is  hard  and 
swollen  to  twice  or  three  times  its  natural  size,  and  the  patient 
is  unable  to  swallow  or  to  open  his  mouth  beyond  a  fraction  of  an 
inch.  The  saliva  dribbles  away;  if  suppuration  occur  the  tonsil 
gradually  softens  until  the  abscess  breaks.  With  the  discharge  of 
the  pus  the  severe  pam  is  relieved  and  the  patient  rapidly  recovers. 
If  the  abscess  is  large,  and  if  the  pus  is  discharged  in  a  backward 
direction,  there  is  danger  from  suffocation,  particularly  if  the  abscess 
breaks  during  sleep.  Fortunately,  the  abscess  usually  points  toward 
the  mouth,  and  the  pus  runs  out. 

Treatment. — Persons  who  are  subject  to  attacks  of  sore  throat 
should  keep  their  feet  dry  and  be  very  careful  not  to  catch  cold. 
If  a  case  develop,  give  a  gargle  of  salt  water  or  potassium  chlorate 
and  water  (saturated  solution),  or  boric  acid  and  water  may  be 
applied  to  the  tonsil.  Dry  bicarbonate  of  soda  (baking  soda)  is 
highly  recommended  as  a  local  application,  a  small  quantity  to  be 
applied  every  hour.  Apply  cold  water  or  a  light  ice  bag  to  the 
neck,  or  a  thick  piece  of  flannel  saturated  with  ice  water  may  be 
placed  around  the  neck  and  covered  with  muslin.  Small  pieces  of 
ice  placed  in  the  mouth  are  usually  agreeable.  The  bowels  should 
be  kept  open  by  means  of  Epsom  salts. 

If  the  cold  applications  to  the  neck  do  not  give  relief,  or  if  they 
are  not  agreeable  to  the  patient,  apply  hot  water  or  poultices  and 
give  hot  gargles,  or  let  the  patient  gargle  with  hot  tea.  If  the  swell- 
ing is  very  great,  he  can  not  gargle.  If  practicable,  send  for  a 
physician. 

MUMPS. 

Mumps  is  an  acute  infectious  disease  usually  affecting  children, 
but  may  occur  in  adults.  It  affects  the  parotid  gland,  which  is 
situated  just  below  the  ear  on  each  side.  It  is  usually  conveyed  by 
contact  from  one  patient  to  another.  Hence,  the  patient  should  be 
isolated  in  a  room,  and  children  should  not  be  exposed  to  the  dis- 
ease. Only  the  adults  directly  in  charge  of  the  case  should  be  ad- 
mitted to  the  room  unless  they  have  been  protected  by  a  previous 
attack.  An  attack  usually  comes  on  about  15  days  after  the  expo- 
sure to  the  disease. 

The  chief  symptoms  are  pain  and  swelling  in  the  parotid  region 
under  the  ear.     Movements  of  the  jaw,  such  as  chewing  and  talking, 


MEDICAL    HANDBOOK.  27 

will  be  painful.  Swelling  may  occur  on  one  or  both  sides,  but  nearly 
always  both  are  involved.  It  is  worst  about  the  third  day,  and  may 
gradually  disappear  after  that.  It  is  usually  a  mild  disease,  but 
swelling  of  the  testicle  is  a  frequent  complication  in  the  male. 

Treatment. — Light  diet,  such  as  broths,  eggs,  milk,  rice  puddings, 
etc.,  should  be  given.  Sour  food  and  acid  drinks  will  be  found  to 
give  considerable  pain  if  taken  in  the  mouth;  hence  they  should  be 
avoided.  Hot  applications  may  be  placed  over  the  swollen  glands 
if  there  is  very  much  pain.  No  internal  medicines  are  indicated.  If 
the  bowels  are  constipated,  a  tablespoonful  of  Epsom  salts  may  be 
administered  with  benefit. 

COUGHS  AND  COLDS. 

When  a  person  has  a  cough  that  lasts  more  than  two  or  three  weeks, 
even  though  the  symptoms  are  mild,  the  case  is  serious  enough  to 
require  an  examination  by  a  physician,  and  one  should  be  consulted 
on  the  first  opportunity. 

A  case  of  bronchitis  or  bad  cold  usually  begins  with  a  cough,  some- 
times starting  with  an  irritation  in  the  throat,  which  gradually 
travels  down  into  the  lungs.  Though  the  cough  at  first  is  chy,  there 
will  be  some  expectoration  later  on,  especially  marked  in  the  morning 
on  first  arising.  It  may  be  at  first  white  and  tenacious,  later  on 
becoming  yellowish.  With  this  there  will  be  some  soreness  over  the 
upper  and  front  part  of  the  chest,  and  if  the  cough  is  violent  there 
win  be  considerable  soreness  of  the  muscles  between  the  ribs. 

Treatment. — For  the  soreness  over  the  chest  a  good  rubbing  with 
soap  hniment  may  help  to  reheve  the  symptom.  A  tablet  of  Brown 
Mixture  given  every  two  hours  is  serviceable.  The  bowels  should 
be  kept  open  by  a  tablespoonful  of  Epsom  salts,  when  necessary. 

Patients  with  coughs  and  colds  should  not  be  kept  in  a  hot,  dry 
room  without  ventilation.  Plenty  of  fresh  air  should  be  allowed  to 
come  into  the  room,  with  the  precaution,  however,  that  the  patient 
be  not  exposed  to  a  draft  and  that  he  be  properly  clothed  so  as  not 
to  become  chilled  when  the  weather  is  cold. 

A  cold  in  the  head  may  often  be  aborted  if  the  patient  when  he 
feels  the  cold  coming  on  will  take  a  hot  bath  or  a  hot  mustard  foot 
bath,  go  to  bed,  drink  hot  lemonade  or  hot  weak  tea,  and  cover  him- 
self up  well  until  a  good  perspiration  is  induced.  Care  should  be  taken 
next  day  to  wrap  up  carefully  if  he  goes  out  of  the  house,  as  other- 
wise the  symptoms  may  return  in  greater  severity.  Aspirin  in  doses 
of  5  to  10  grains  every  three  hours  may  be  taken  during  a  cold,  if 
there  is  headache  or  pain  in  the  limbs. 


28  LIGHTHOUSE    SEEVICE. 

CONSUMPTION  (TUBERCULOSIS). 

The  first  noticeable  symptom  of  tuberculosis  of  the  lungs  may  be 
a  hemorrhage,  the  blood  being  coughed  up,  but  the  onset  is  usually 
gradual.  The  patient  has  a  shght  cough,  feels  weak,  and  indisposed 
to  do  anything,  loses  weight,  and  has  very  little  appetite.  If  the 
temperature  is  taken  in  the  evening,  it  will  often  be  found  that  he 
has  a  slight  fever.  In  a  few  weeks  or  months  the  emaciation  becomes 
more  marked,  the  fever  is  higher,  there  are  sweats  at  night,  severe 
cough,  shortness  of  breath,  and  a  large  amount  of  mucopurulent 
matter  is  expectorated.  There  may  be  severe  diarrhea  from  exten- 
sion of  the  disease  to  the  bowel,  or  the  larynx  may  be  involved, 
causing  the  voice  to  be  husky  and  swallowing  extremely  painful. 
The  patient's  sleep  is  disturbed  by  the  coughing  spells,  which  are 
violent  and  protracted.  As  the  disease  progresses  the  symptoms 
increase  in  severity  and  the  patient  is  confmed  to  his  bed  untH  death 
brings  him  relief  from  his  suffering. 

Treatment. — A  person  who  has  consumption  should  Hve  out  of 
doors.  He  should  not  go  into  a  house  except  to  dress  or  to  get  his 
meals.  At  night  he  should  sleep  on  a  porch,  balcony,  or  lean-to,  where 
he  will  be  in  the  open  air.  Many  persons  who  conscientiously  foUow 
this  treatment  recover. 

There  is  httle  danger  of  a  person  infecting  others  in  the  same  house 
if  he  will  take  the  proper  precautions.  The  danger  lies  in  the  sputum, 
which,  after  drying,  is  mhaled  by  others  in  the  form  of  dust.  To 
prevent  this,  a  consumptive  should  neverspit  upon  the  floor  or  ground. 
The  sputum  should  be  caught  on  tissue  paper,  which  should  be  placed 
after  use  in  a  paper  bag.  This  bag  and  its  contents  should  be  burned 
in  a  few  hours,  before  the  sputum  has  had  time  to  dry.  If  the  sputum 
is  profuse,  a  cup  with  a  cover  may  be  employed,  but  this  cup  should 
be  boiled  for  half  an  hour  several  times  each  day.  It  is  well  also 
to  keep  the  cup  partially  filled  with  a  3  per  cent  carbohc  acid  solution. 

Handkerchiefs  or  pieces  of  cloth  should  not  be  used  for  wiping  the 
mouth  or  nose  unless  they  are  boiled  immediately  afterwards.  Sheets 
and  pillowcases  which  may  be  soiled  during  the  night  by  the  sputum 
should  be  boiled  the  first  thing  m  the  morning.  Towels  used  by  the 
patient  should  be  boiled  immediately  thereafter.  The  patient  should 
have  separate  dishes  and  these  should  be  sterilized  by  boiling  after 
each  meal.  He  should  keep  his  face  clean  shaved,  and  he  should  kiss 
no  one,  nor  should  he  under  any  circumstances  sleep  in  the  same  bed 
or  the  same  room  with  other  persons.  After  death  the  room  should 
be  disinfected  as  described  under  "Measles." 

It  is  dangerous  to  allow  a  seaman  with  consumption  to  remain 
aboard  his  vessel,  as  there  are  so  many  opportunities  for  conveying 
the  disease  to  well  persons.     Such  seaman  should  be  sent  to  the  near- 


MEDICAL   HANDBOOK,  29 

est  marine  hospital,  from  which  he  will  be  transferred,  if  the  disease 
is  not  too  far  advanced,  to  the  sanatorium  at  Fort  Stanton,  N.  Mex., 
maintained  for  the  care  and  treatment  of  consumptive  seamen  by  the 
United  States  Pubhc  Health  Service.  After  the  seaman  has  been 
taken  from  the  vessel  the  master  should  request  the  nearest  officer  of 
the  Public  Health  Service  to  disinfect  the  forecastle  or  stateroom 
which  the  sick  man  has  occupied. 

TYPHOID  FEVER. 

Typhoid  fever  is  caused  by  a  germ  loiown  as  the  bacillus  typhosus. 
This  bacillus  is  found  in  the  discharges  of  persons  sick  with  the  disease 
and  sometimes  for  a  considerable  time  after  their  recovery.  When 
the  food  or  drink  of  well  persons  becomes  contaminated  with  these 
discharges,  typhoid  fever  is  apt  to  result.  This  contamination  may 
be  brought  about  by  means  of  flies  which  convey  small  particles  of 
fecal  matter  containmg  the  bacillus  of  typhoid  fever  from  privies  to 
Idtchens  and  dining  rooms,  and  soil  the  food  by  lighting  upon  it. 
Drmkuig  water  may  become  infected  through  the  drainage  of  a  cess- 
pool into  a  well  or  near-by  stream.  Milk  may  carry  the  disease 
through  washing  the  cans  with  such  water.  Persons  caring  for 
typhoid  fever  cases  may  infect  themselves  or  others  if  they  are  not 
careful.  Finally,  there  are  patients  who  have  recovered  from  the 
disease  but  who  still  have  typhoid  baciUi  in  their  stools.  These  indi- 
viduals are  called  "carriers"  and  may  cause  sickness  among  many 
other  persons.  This  is  especially  the  case  if  they  are  employed  in 
milking  cows  or  m  the  preparation  of  food. 

Typhoid  fever  begins  with  headache,  diarrhea,  cramps  in  the 
abdomen,  nosebleed,  loss  of  appetite,  coated  tongue,  dry  mouth,  and 
fever,  which  is  higher  each  day  than  on  the  day  previous.  The  stools 
are  foul  smelling  and  of  the  color  and  consistency  of  pea  soup.  In 
mild  cases  some  of  these  symptoms  may  be  absent.  As  a  general 
thing  the  patient  has  been  feeling  badly  for  several  days  before  the 
attack  begins.  At  the  end  of  the  first  week  the  patient  is  duU  and 
apathetic,  twitches  his  fingers,  and  picks  at  the  bedclothes.  There 
may  be  a  low  muttering  dehrium.  The  abdomen  is  distended  with 
gas,  and  small  rose-colored  spots  appear  here  and  there  on  the  body. 
Later  on  there  may  be  hemorrhage  due  to  ulceration  of  the  bowel. 
Sometimes  an  ulcer  will  perforate  the  intestine,  and  allow  its  contents 
to  enter  the  general  abdominal  cavity;  this  usually  causes  death  in  a 
few  hours.  When  hemorrhage  or  perforation  occurs  there  is  severe 
pain  and  the  signs  of  shock  are  present.  The  pulse  is  weak  and 
thready,  the  face  is  pale,  the  skin  damp,  and  the  temperature  falls  to 
normal. 

Abscesses  and  boils  may  form  in  various  parts  of  the  body,  and 
bedsores  are  not  imcommon.     In  persons  who  have  used  stimulants 


30  LIGHTHOUSE    SERVICE. 

freely  delirium  tremens  may  be  a  prominent  symptom.     Pneumonia 
and  meningitis  are  occasional  complications. 

Treatment. — Place  the  patient  in  bed  and  do  not  let  him  get  up. 
When  he  desires  to  have  an  action  of  the  bowels,  the  bedpan  should 
be  used.  He  should  have  a  liquid  diet,  plenty  of  water,  milk,  and 
thin  soups;  no  soHd  food  should  be  given  until  10  days  after  the  fever 
has  subsided.  Tlie  temperature  should  be  watched  and  the  patient 
bathed  with  cold  water  whenever  the  fever  rises  above  39°  C.  (102.2° 
F.).  Ice  bags,  if  obtainable,  applied  to  his  abdomen  and  chest  will 
assist  in  keeping  the  temperature  down.  One  should  also  be  applied 
to  the  head  if  there  is  delirium.  If  there  is  distension  of  the  abdomen 
hot  turpentine  stupes  should  be  apphed.  This  is  done  by  wringing  a 
double  layer  of  thin  flannel  out  of  hot  water  with  which  a  teaspoonful 
of  turpentine  has  been  mixed.  An  injection  of  a  pint  of  warm  water 
containing  a  teaspoonful  of  turpentine  is  also  beneficial.  Stimulants 
should  not  be  given  except  in  collapse. 

No  person  caring  for  a  typhoid-fever  patient  should  prepare  food 
for  others.  The  nurse  should  wash  her  hands  carefully  after  waiting 
upon  the  patient  and  before  she  eats  her  meals.  After  washing,  they 
should  be  immersed  in  a  1  to  2,000  solution  of  bichloride  of  mercury 
for  a  few  minutes.  AU  water  employed  in  washing  the  nurse's  hands 
or  in  bathing  the  patient  should  be  boiled  m  a  bucket  or  wash  boiler 
kept  for  this  purpose.  All  towels  and  bed  linen  used  in  the  sick  room 
must  be  boiled.  The  patient's  urine  and  feces  must  be  boded  before 
being  thrown  out,  and  the  bedpan  and  urinal  sterihzed  by  boiling 
water  immediately  after  being  emptied. 

Typhoid  prophylaxis. — When  typhoid  fever  is  prevalent  everyone 
should  be  inoculated  with  antityphoid  vaccine  to  prevent  taking  the 
disease.  This  vaccine  has  practically  eliminated  this  disease  from  the 
Army.  AU  seamen  should  apply  to  officers  of  the  Public  Health 
Service  for  this  treatment,  as  the  protection  afforded  wiU  save  much 
suffering  which  they  now  undergo.  During  the  fiscal  year  1914  there 
were  372  cases  of  typhoid  fever  among  sadors,  of  whom  37  died;  if 
this  vaccine  had  been  administered  to  these  men  before  they  were 
taken  sick,  it  is  safe  to  say,  none  of  them  would  have  had  the  fever. 
An  attack  of  typhoid  fever  usually  lasts  two  months,  and  the  patient 
is  as  a  rule  too  weak  to  do  much  work  for  another  month,  so  that  at 
least  75  days  are  lost  by  each  attack  of  this  disease.  From  the  above 
calculation  it  wiU  be  seen  that  this  would  amount  to  25,125  days' 
sickness  for  those  that  survived. 

WeUs  suspected  of  being  infected  with  sewage  should  be  closed 
imtil  it  is  proved  that  such  contamination  has  not  taken  place.  If  it 
is  necessary  to  use  water  that  is  suspicious,  it  should  first  be  boded 
or  treated  with  hypochlorite  of  lime,  one-half  teaspoonful  to  every  80 
gallons  of  water.     The  lime  should  be  dry  and  only  that  taken  from 


MEDICAL  HANDBOOK.  31 

a  freshly  opened  can  should  be  used.  During  a  typhoid  epidemic 
milk  should  be  pastuerized.  This  is  done  by  heating  the  milk  to  160° 
F.  and  keeping  it  at  that  temperature  for  half  an  hour. 

DELIRIUM  TREMENS. 

Delirium  tremens  occurs  as  an  incident  in  the  life  of  persons 
addicted  to  the  excessive  use  of  intoxicating  hquors. 

Loss  of  appetite,  sleeplessness,  or  a  marked  mental  depression  are 
the  chief  symptoms  of  the  first  stage  of  the  affection  which  is  known 
among  drunkards  as  "the  horrors." 

As  the  disease  advances  the  patient  talks  incoherently;  has  a  wild 
expression;  his  mind  wanders  from  one  thing  to  another.  He  an- 
swers questions  in  a  rambling  manner.  He  fancies  he  is  being  pur- 
sued by  wild  animals  or  that  he  sees  rats,  snakes,  and  other  animals 
crawling  on  the  walls  or  around  his  bed,  or  he  may  imagine  himself 
to  be  engaged  in  his  regular  duties  or  as  master  of  the  ship,  giving 
directions  to  the  men. 

The  dehrium  is  always  worse  at  night,  but  the  patient  requires 
careful  watching  all  the  time.  He  may  try  to  jump  overboard  or 
commit  suicide. 

Dehrium  tremens  may  be  confounded  with  acute  inflammation  of 
the  brain  or  with  acute  mania  (insanity)  or  with  certain  forms  of 
pneumonia,  and  any  one  of  these  diseases  may  also  be  present. 
Pneumonia  is  a  frequent  comphcation  of  delirium  tremens,  and  in 
fatal  cases  may  be  the  direct  cause  of  death. 

In  favorable  cases  the  symptoms  begin  to  improve  in  three  or  four 
days  from  the  onset.     The  patient  sleeps  and  gradually  recovers. 

Treatment. — The  patient  requires  constant  attendance.  Physical 
restraint  should  be  avoided  if  possible.  To  support  the  patient  and 
to  procure  sleep  are  the  great  objects  of  treatment.  Careful  feeding 
is  very  important.  Milk  or  concentrated  broths  should  be  given  at 
regular  intervals  of  two  hours.  A  cold  bath  is  of  value  in  some 
cases,  especially  if  agreeable  to  the  patient.  In  other  cases  a  warm 
bath  or  a  hot  foot  bath  may  have  a  better  effect. 

The  serious  symptoms  are  largely,  if  not  entirely,  due  to  the  sleep- 
lessness, and  if  several  hours  of  sound  sleep  can  be  procm'ed  improve- 
ment is  almost  sure  to  follow.  To  this  end  potassium  bromide  in 
30-grain  doses  may  be  given  in  water  every  three  hours.  Morphia 
or  opium  are  not  to  be  recommended  in  this  disease  except  under 
the  immediate  direction  of  a  physician.  All  stimulants  should  be 
withheld  except  in  rare  cases  when  the  pulse  is  weak.  The  giving  of 
whisky,  gin,  etc.,  in  small  doses  to  gradually  "sober  him  up"  is  a 
bad  practice,  as  it  delays  the  patient's  recovery.  No  amount  of  beg- 
ging for  stimulants  on  the  part  of  the  patient  should  persuade  his 
attendants  to  break  this  rule. 


32  UGHTHOUSE   SERVICE. 

SUNSTROKE. 

The  term  "sunstroke"  denotes  a  sudden  attack  of  illness  from 
exposure  or  prolonged  exposure  to  the  rays  of  the  sun;  but  the  same 
condition  may  be  produced  in  hot  weather  by  exposure  to  high  tem- 
perature not  in  the  direct  rays  of  the  sun,  particularly  if  the  person 
is  engaged  at  hard  work  in  close  quarters.  Stokers  on  steamships  are 
sometimes  affected  by  the  heat  of  the  furnace.  Men  debihtated  from 
or  addicted  to  the  excessive  use  of  stimulants  are  more  apt  to  suffer 
than  those  of  temperate  habits. 

Sunstroke  occurs  in  two  forms:  Heat  stroke  (heat  fever),  in  which 
the  temperature  of  the  body  is  very  high,  and  heat  prostration  or 
heat  exhaustion,  in  which  the  surface  of  the  body  is  cool,  sometimes  ■ 
considerably  below  normal.     The  difference  is  very  important  because 
of  the  different  treatment  required. 

In  severe  cases  of  heat  stroke  the  patient  may  be  stricken  down 
in  a  state  of  unconsciousness  and  die  instantly  or  within  an  hour  or 
two.  In  other  cases  there  may  be  intense  headache,  dizziness,  marked 
restlessness,  nausea  and  vomiting,  and  hot  "burning"  skin.  The 
thermometer  may  register  105°  F.  Pulse  is  fuU  and  may  be  slow  or 
fast.  Breathing  is  labored,  xnay  be  sighing  or  rattling.  Patient  soon 
becomes  unconscious,  the  stupor  deepens,  and  death  may  occur  within 
24  hours;  or  the  temperature  may  drop,  consciousness  may  return, 
and  the  patient  get  well. 

In  heat  prostration,  as  already  stated,  the  surface  of  the  body  is 
cool,  the  pulse  rapid  and  feeble,  and  there  is  a  feehng  of  general 
weakness.  There  may  be  only  slight  f  aintness  and  nausea,  and  under 
prompt  treatment  patient  may  rapidly  recover,  or,  on  the  other  hand, 
there  may  be  complete  loss  of  consciousness  and  a  rapid  and  fatal 
termination  from  exhaustion. 

Heat  cramps. — Pamful  spasms  of  the  muscles,  especially  those  of 
the  abdomen  and  limbs,  may  occur  when  persons  who  are  exposed  to 
high  temperatm-es  are  required  to  perform  hard  labor.  Stokers  on 
steamships  are  hable  to  suffer  from  them.  They  are  extremely  pain- 
ful, making  the  patient  cry  out;  there  is  headache  and  the  bowels  are 
constipated.  In  some  cases  the  patient  is  unconscious,  and  the  con- 
vulsions resemble  those  of  epilepsy.  The  attacks  may  last  from  12 
to  24  hours,  but  even  after  the  patient  becomes  quiet  the  spasms 
may  be  renewed  by  a  shght  stimulus,  such  as  a  cold  draft  or  a  sudden 
movement.  The  muscles  are  sore  and  the  patient  weak  and  hstless 
for  several  days  following  the  seizure.  The  cases  vary  greatly  in 
intensity;  there  may  be  simply  a  shght  cramp  in  the  abdomen  or  in 
one  of  the  muscles  of  an  extreniity. 

Treatment. — In  heat  stroke  (fever  heat)  the  temperature  of  the 
body  should  be  reduced  as  rapidly  as  possible.     Place  the  patient  in 


MEDICAL   HANDBOOK.  33 

a  cold-water  bath,  add  ice,  rub  the  body  with  the  blocks  of  ice, 
apply  iced  water  with  ice  cap  to  his  head;  and  keep  up  the  treat- 
ment until  the  temperature,  as  shown  by  the  thermometer  in  the 
rectum,  is  reduced  to  100°  F.  If  the  temperature  rise  agam,  repeat 
the  treatment.  If  symptoms  of  exhaustion  foUow  the  reduction  of 
the  temperature,  stimulants  should  be  given — strychnia  sulphate, 
one-fortieth  grain. 

In  heat  prostration,  with  cool  skin,  weak  and  rapid  pulse,  stimu- 
lants and  friction  are  required.  Give  strychnia  sulphate,  one-fortieth 
grain,  rub  the  surface  of  the  body. and  the  extremities,  place  hot- 
water  bottles  to  the  feet,  and  cover  the  body  with  blankets.  If  the 
head  is  hot,  apply  cold  water  to  the  forehead.  If  vomiting  occur, 
inject  stimulants  into  the  rectum.  Apply  mustard  over  the  region 
of  the  stomach.     Mustard  may  also  be  applied  to  the  feet. 

Heat  cramps. — Twenty  drops  of  tincture  of  nux  vomica  in  a  glass 
of  water  taken  three  times  a  day  will  often  prevent  these  cramps. 
Oatmeal  water  should  be  used  by  the  firemen  to  quench  their  thirst. 
If  a  fireman  feels  faint,  a  cup  of  strong  tea  will  frequently  revive 
him.  The  minor  spasms  in  the  muscles  of  the  arms  and  legs  are 
usually  treated  by  the  men  themselves  by  rubbing  each  other. 
VSThen  the  cramps  are  severe  the  patient  should  be  placed  in  a  hot 
bath,  the  muscles  vigorously  rubbed,  and  large  quantities  of  hot 
water  given  by  the  mouth  and  injected  into  the  bowel.  Thirty 
grains  of  bromide  of  potash  should  be  given  in  half  a  glass  of  water. 
If  the  patient  can  not  retain  this,  60  grains  in  a  pint  of  water  should 
be  administered  by  the  rectum.  The  next  day  every  effort  should 
be  made  to  get  the  patient's  bowels  opened  by  giving  him  castor  oil 
or  salts  or  mjection  of  soapy  water. 

HEADACHE. 

Headache  is  a  symptom  of  disease  of  some  portion  of  the  body. 
When  it  is  unilateral,  localized,  sharp,  and  paroxysmal  it  is  known 
as  neuralgia.  It  may  be  caused  by  many  conditions,  among  which 
may  be  mentioned  derangements  of  the  stomach  and  liver,  constipa- 
tion, neurasthenia,  eyestrain,  heat  exhaustion,  exposure  to  cold  and 
dampness,  inflammation  of  the  kidneys  or  genital  organs.  It  is 
present  in  malarial  fever,  typhoid  fever,  smallpox,  syphilis,  diabetes, 
and  mfluenza.  In  meningitis  or  inflammation  of  the  coverings  of 
the  braiu  the  pam  in  head  is  excruciating.  Many  of  the  diseases  of 
childhood  begin  with  headache. 

Treatment. — Remove  the  cause,  if  possible.  Open  the  bowels  with 
a  dose  of  castor  oil  or  salts.  Take  10  grains  of  aspirin  and  repeat 
if  necessary  in  three  hours.  A  little  hot  tea  and  toast  should  be 
given  with  this  medicine  to  prevent  nausea.  If  the  headaches  are 
frequent,  a  physician  should  be  consulted  to  ascertain  the  cause. 
98908°— 15 3 


34  OGHTHOUSE   SERVICE. 

ERYSIPELAS  (ST.  ANTHONY'S  FIRE). 

Erysipelas  is  an  inflammation  of  the  skin.  It  usually  begins  with 
a  chill,  followed  by  a  high  fever.  It  is  a  frequent  complication  of 
wounds,  but  is  more  frequently  developed  without  any  apparent 
injury.  A  large  majority  of  cases  begin  on  the  face,  usually  on  the 
nose,  first  as  a  small  red  spot,  which  is  soon  elevated  above  the 
surrounding  skin,  and  gradually  or  rapidly  spreads  over  the  face  and 
ears,  and  not  infrequently  over  the  entire  hairy  scalp;  sometimes  over 
the  neck  and  chest,  and  occasionally  down  the  back,  and  to  other 
parts  of  the  body.  The  skin  is  painful,  red,  hot,  and  swollen,  and 
blisters  frequently  form.  The  sweUing  may  be  most  marked  about 
the  eyes  and  ears,  the  eyes  closed,  and  the  patient's  features  changed 
and  distorted  to  such  a  degree  that  the  appearance  once  seen  wiU  not 
soon  be  forgotten.  The  disease  limited  to  the  face  and  scalp  usually 
runs  its  course  in  a  few  days  or  a  week,  but  sometimes  before  the  face 
is  healed  red  spots  appear  on  other  parts  of  the  body,  and  the  case 
may  be  prolonged.     Abscesses  beneath  the  skin  are  not  uncommon. 

Besides  the  symptoms  already  mentioned  there  are  headache,  loss 
of  appetite,  coated  tongue,  frequently  vomiting,  and  in  some  cases 
delirium  and  marked  depression. 

The  outcome  is  usually  favorable,  but  in  drunkards  or  in  persons 
debilitated  from  previous  diseases  death  is  sometimes  the  result. 

Treatment. — Erysipelas  is  only  shghtly  contagious  under  ordinary 
circumstances ;  but  persons  suffering  from  wounds  or  scratches  of  the 
skin  are  very  apt  to  be  attacked.  The  patient  should  therefore  be 
isolated — placed  in  a  room  by  himself — and  his  attendant  should  be 
a  healthy  man  and  free  from  any  skin  injury. 

Erysipelas  being  a  seh-hmited  disease,  it  is  a  common  saying 
among  physicians  that  the  majority  of  ordinary  or  moderately  severe 
cases  would  get  well  without  any  treatment.  But  this  is  probably 
true  of  many  other  diseases,  and  while  it  may  be  difficult,  perhaps 
impossible,  to  limit  the  spread  of  the  eruption  or  shorten  the  course 
of  the  disease  in  a  given  case  of  erysipelas,  something  may  be  done 
to  relieve  distressing  symptoms  and,  particularly  in  feeble  persons, 
to  fortify  the  system  against  the  attack.  "Treat  the  patient  rather 
than  the  disease"  is  good  advice  in  more  troubles  than  one. 

The  oldest  and  one  of  the  best  local  applications  for  erysipelas  is 
cold  water,  and  if  the  fever  is  very  high  cold  sponging  of  the  entire 
body  or  a  cold  bath  may  afford  considerable  relief.  Bismuth  sub- 
nitrate  may  be  dusted  over,  or  petrolatum  may  be  apphed  to  the  skin. 
In  feeble  persons  stimulants  may  be  required. 

POISON  IVY. 

Contact  of  the  skin  with  the  poison  ivy  causes  in  many  people  a 
very  annoying  inflammation  of  the  skin.  The  vine  is  of  the  climbing 
variety,  with  three  pointed  leaves  on  each  stem.     A  few  hours  or 


MEDICAL    HANDBOOK.  35 

about  a  day  after  the  skin  is  exposed  to  the  poison  of  this  plant  a  red 
rash  appears,  with  more  or  less  swelling  and  itching;  small  blisters 
appear,  filled  with  serum,  even  becoming  quite  large.  When  they 
burst,  there  is  considerable  weeping  from  the  surface.  Later  it  may 
go  on  to  a  formation  of  pus.  The  hands  and  face,  being  the  most 
exposed  parts  of  the  body,  and  the  feet  and  ankles  of  those  who  go 
barefooted,  are  usually  first  affected.  If  the  inflammation  is  very 
severe,  there  may  be  some  incidental  disturbance,  such  as  fever, 
headache,  and  general  feeling  of  malaise. 

Treatment. — One  of  the  best  treatments  for  this  disease  is  bathins: 
with  salt  wa.ter,  sea  water  being  the  best.  Boric  acid,  about  15 
grains  to  the  ounce,  is  a  good  appUcation.  The  large  blisters  should 
be  punctured  and  the  contents  allowed  to  run  out.  Every  one  or 
two  days  the  affected  parts  should  be  bathed  with  warm  water,  care- 
fully dried  without  rubbing,  and  the  boric  acid  treatment  resumed. 

BOILS. 

A  boil  is  a  circumscribed  inflammation  of  the  skin  and  connective 
tissue.  It  is  often  caused  by  infection  foUo^ang  a  slight  Avound  or 
scratch  of  the  skin,  but  may  occur  apparently  without  any  cause.  It 
begins  as  a  small  red  pimple  and  gradually  increases  in  size  and 
forms  a  dusky  red  sweUing,  the  size  of  a  silver  doUar  or  less.  The 
central  portion  of  the  sweUing  sloughs  or  forms  a  "core,"  and  as 
soon  as  the  core  is  separated  or  cast  off  the  inflammation  subsides,  the 
pain  lessens,  and  the  ulcer  begins  to  heal. 

Treatment. — Compresses  made  of  aseptic  gauze  or  clean  white 
cotton  cloth  wet  with  a  1  to  5,000  hot  solution  of  bichloride  of  mercury 
should  be  appHed  every  two  hours  until  the  central  portion  of  the  boil 
is  softened.  The  bichloride  solution  should  be  made  in  a  metal  basin 
or  some  utensil  not  employed  in  cooking  or  for  holding  drinking 
water.  The  solution  should  be  heated  each  time  it  is  used,  and  in  the 
intervals  it  should  be  kept  upon  a  high  shelf,  so  that  no  person  or 
animal  may  be  poisoned  by  it.  The  separation  of  the  core  of  the  boil 
may  be  aided  by  an  incision.  This  incision  should  be  made  through 
the  thickened  tissues  of  the  edge  of  the  boil  by  a  thin  sharp  blade 
previously  sterilized  by  boiUng.  The  blade  should  be  wrapped  in 
cotton  before  boiling,  and  a  Httle  soda  added  to  the  water  to  prevent 
the  edge  of  the  knife  from  becoming  dull.  After  the  core  is  discharged, 
the  ulcer  should  be  washed  daily  with  the  bichloride  solution  and 
dressed  with  dry  sterile  gauze. 

FAINTING. 

Treatment. — When  a  person  feels  faint,  or  actuaUy  faints,  he 
should  be  laid  flat  upon  the  bed  or  the  floor,  with  the  head  at  least 
as  low  as  the  body,  and  the  clothing  around  the  neck  and  chest 


36  LIGHTHOUSE    SEEVICB. 

loosened.  A  teaspoonful  of  aromatic  spirits  of  ammonia  should  be 
given  in  a  third  of  a  glass  of  water.  He  should  remain  in  this  reclining 
position  until  the  attack  has  passed  off. 

DYSENTERY. 

Dysentery,  or  bloody  flux,  as  it  is  sometimes  called,  is  an  affection — 
an  inflammation  and  ulceration — of  the  mucous  membrane  of  the 
large  bowel.  It  occurs  in  different  degrees  of  severity.  It  may  be 
acute  or  chronic.  There  are  different  varieties.  Its  severest  form  is 
met  with  in  tropical  countries,  where  it  frequently  occurs  in  wide- 
spread epidemics.  Epidemics  also  occur  in  temperate  regions.  Spo- 
radic cases  may  be  found  almost  everywhere.  The  disease  prevails 
in  summer  and  autumn.     It  may  attack  an  entire  ship's  crew. 

Bad  food,  unripe  fruit,  impure  drinking  water,  exposure  to  cold 
and  dampness,  while  probably  not  in  themselves  the  direct  cause  of 
dysentery,  doubtless  favor  the  operation  of  other  causes. 

Symptoms. — The  onset  may  be  sudden  or  gradual.  There  may  or 
may  not  be  chiUs  or  chiUiness.  There  is  usually  some  feverishness. 
The  tongue  is  furred  and  moist,  but  soon  becomes  red  and  dry  or 
brownish  and  glazed. 

The  first  stools  may  be  like  those  of  an  ordinary  diarrhea.  After 
a  day  or  two,  or  maybe  within  a  few  hours,  these  are  replaced  by 
small  mucous  stools  frequently  mixed  with  blood  and  small  particles 
of  fecal  matter.  Soon  the  evacuations  consist  of  mucus  alone,  or  of 
blood  and  mucus,  or  of  a  jeUy-hke  matter  and  small  white  clumps 
of  mucus.  Later  they  may  be  shreddy,  and  brownish  or  greenish  in 
color.  Patient  complains  of  cramps  and  "colicky"  pains  in  his 
beUy;  a  burning  sensation  in  the  rectum,  with  a  feeling  as  if  some- 
thing must  be  expelled,  and  of  a  constant  desire  to  go  to  stool.  The 
evacuations  may  number  from  10  to  20,  or  40  to  50,  or  even  100  or 
more  a  day,  according  to  the  severity  of  the  case.  The  quantity  of 
each  may  not  exceed  a  teaspoonful. 

In  mild  cases  there  is  a  gradual  change  to  normal,  and  patient  may 
recover  after  a  period  of  a  week  or  10  days.  Severer  cases  continue 
for  several  weeks  or  longer  and  then  recover,  or  become  chronic  and 
incurable,  or  death  may  occur  from  general  wcalaiess. 

Tropical  dysentery,  the  variety  which  occurs  most  frequently  and 
in  epidemic  form  in  tropical  or  subtropical  regions,  but  also  occa- 
sionally in  temperate  climates,  is  said  to  be  produced  by  a  micro- 
organism which  enters  the  system  in  drinking  water. 

The  symptoms  in  this  form  of  dysentery  are  similar  to  those 
already  described.  The  burning  sensation  and  bearing-down  pain, 
however,  are  less  marked.  The  stools  are  less  frequent,  but  they 
are  larger  and  more  watery ;  at  times  more  like  diarrhea  than  typical 
dysentery.     The  disease  in  favorable  cases  runs  a  course  of  from 


MEDICAL  HANDBOOK.  37 

6  to  12  weeks.  Recovery  is  always  slow.  Death  may  occur  from 
exhaustion,  or  from  abscess  of  the  liver,  which  is  a  common  compU- 
cation.  In  the  most  fatal  epidemics  the  course  of  the  disease  is  very 
rapid.     Death  sometimes  occurs  within  a  few  hours. 

Treatment. — Rest  in  bed.  If  possible,  the  patient  should  use  the 
bedpan  instead  of  the  commode  or  closet,  so  as  to  insure  the  greatest 
amount  of  rest,  which  is  very  important.  Stop  aU  solid  food.  Give 
2  tablespoonfuls  (30  c.  c.)  of  castor  oil  and  15  drops  of  laudanum 
in  one  dose,  and,  if  necessary,  repeat  the  dose  in  six  hours,  or  give 
smaller  doses  at  intervals  of  four  hours.  After  the  bowels  have 
been  thoroughly  cleared  out,  a  pill  of  camphor  and  opium  should 
be  given  every  three  hours.  Hot  applications  should  be  placed  on 
the  abdomen.  The  bearing-down  pain  and  the  burning  sensation 
may  be  reHeved  by  washing  out  the  rectum  with  a  pint  of  warm 
water  and  by  injecting  2  ounces  of  thin  starch  containing  25  or  30 
drops  of  laudanum. 

In  place  of  the  castor  oil,  Epsom  salts  may  be  given  in  tablespoon- 
ful  doses,  repeated  every  two  hours  until  a  free  and  large  action  of 
the  bowels  results,  and  then  the  pill  of  camphor  and  opium  given 
every  three  hours.  Or,  instead  of  the  camphor  and  opium  pills, 
bismuth  subnitrate  may  be  given  in  30  or  40  grain  (2  gm.  or  2.6  gm.) 
doses. 

After  two  or  three  days,  if  the  disease  continues,  the  castor  oil  or 
the  Epsom  salts  may  be  repeated,  and  after  its  effect  is  produced, 
the  same  hne  of  treatment  continued. 

The  diet  should  be  limited  to  the  lightest  articles,  such  as  thin 
porridge,  milk,  and  broths.  And  even  in  the  lightest  cases  the  pa- 
tient should  be  kept  warm  in  bed. 

The  best  means  of  protection  or  prevention  is  to  keep  the  body  in 
sound  condition.  If  the  disease  occurs  among  a  ship's  crew,  the 
healthy  men  should  be  very  careful  not  to  catch  cold,  and  to  avoid 
errors  in  eating  and  drinking.  Sudden  changes  of  temperature 
should  be  guarded  against  by  a  proper  supply  of  clothing.  The 
drinking  water  should  be  boiled. 

Tropical  dysentery  should  be  treated  by  injections  of  large  amounts 
of  cold  water  (45°  F.),  containing  1  part  of  sulphate  of  quinine  to 
5,000  parts  of  water,  into  the  bowel.  Hypodermic  injections  of 
emetin  hydrochloride,  one-half  grain  three  times  a  day,  is,  however, 
the  best  treatment.  When  this  drug  can  not  be  obtained,  salol- 
coated  capsules  of  powdered  ipecac  may  be  used  instead. 

DIARRHEA. 

Acute  diarrhea  is  caused  by  acute  inflammation  or  by  irritation  of 
the  intestines.  It  may  occur  as  a  comphcation  in  many  different 
diseases.  It  is  usually  one  of  the  symptoms  of  typhoid  fever.  It  is 
not  infrequently  met  with  in  severe  cases  of  malaria.     It  is  called 


38  UGHTHOUSE   SEEVICE. 

functional  or  simple  diarrhea  when  it  occurs  independently  of  any 
other  appreciable  disease.  It  may  be  caused  by  exposure  to  cold  or 
by  errors  in  diet. 

In  simple  diarrhea  there  may  or  may  not  be  griping  and  colicky 
pains.  In  the  more  severe  forms  the  tongue  is  coated  and  there  is 
some  fever.  Thirst  is  marked  in  proportion  to  the  size  and  frequency 
of  the  thin  or  watery  discharges.  If  the  rectum  is  affected,  there  is  a 
constant  desire  to  go  to  stool,  and  a  burning  sensation  and  bearing- 
down  pain,  as  in  dysentery. 

Diarrhea  may  last  from  a  few  hours  to  as  many  days,  or  longer. 
It  may  become  chronic. 

Treatment. — In  aU  cases,  rest  and  hght  diet.  In  the  milder  forms 
nothing  further  may  be  required.  Twenty  grains  of  bismuth  sub- 
nitrate  with  5  grains  of  salol  may  be  given  every  three  hours.  In 
the  more  severe  forms  it  is  a  good  plan  to  begin  with  a  dose  of  1  or 
2  tablespoonfuls  of  castor  oil,  to  which  10  or  12  drops  of  laudanum 
may  be  added,  or  in  place  of  the  oil  and  laudanum  Epsom  salts  may 
be  given.  The  diet  should  be  hmited  to  light  articles,  such  as  corn- 
starch, gruel,  weak  broths,  soft-boiled  eggs,  milk,  and  thoroughly 
toasted  bread.  As  a  rule,  in  very  acute  cases,  the  less  food  and 
drink  taken  the  better.  The  patient  should  rest  in  bed  and  keep  his 
body  warm. 

After  the  bowels  have  been  freely  moved  by  the  oil  or  salts,  if  the 
diarrhea  or  pain  continue,  give  one  camphor  and  opium  pill,  and,  if 
necessary,  repeat  the  dose  after  an  interval  of  three  or  four  hours. 
If  nausea  and  vomiting  occur,  apply  mustard  to  the  region  of  the 
stomach,  and  give  tablespoonful  doses  of  equal  parts  of  milk  and 
limewater. 

In  chronic  diarrhea  careful  attention  to  diet  is  of  the  greatest  im- 
portance.    The  treatment  is  about  the  same  as  for  chronic  dysentery. 

CHOLERA  MORBUS  (SPORADIC  CHOLERA). 

Cholera  morbus  is  an  affection  of  the  stomach  and  intestines, 
attended  by  vomiting,  purging,  and  cramps.  It  comes  on  suddenly, 
and  may  begin  by  vomiting  or  purging.  It  is  usually  met  with  dur- 
itig  the  hot  months  of  summer.  It  is  frequently  caused  by  eating 
unripe  and  indigestible  fruits  and  vegetables,  decomposed  or  im- 
properly cooked  fish,  shellfish,  or  salad  mixtm^es.  Drinking  large 
quantities  of  iced  water  and  sudden  checking  of  the  perspiration,  or 
irritants  of  any  kind,  may  set  up  the  trouble.  The  disease  usually 
begins  suddenly,  often  at  night,  with  vomiting,  after  a  feeling  of 
uneasiness,  nausea,  or  a  severe  cramp.  The  contents  of  the  stomach 
are  first  thrown  up,  then  a  bihous  matter.  The  stools  are  at  first 
solid  or  semisolid,  but  they  soon  become  more  watery,  lose  their  color, 
and  sometimes  appear  not  unlike  the  rice-water  stools  of  genuine 
Asiatic  cholera.     The  patient  soon  has  a  wasted  look.     His  thirst 


MEDICAL   HANDBOOK.  39 

is  unquenchable.  His  skin  may  become  cold  and  clammy  and  the 
pulse  very  weak.  Cramps  may  occur  in  the  feet  and  in  the  calves 
of  the  legs.  The  disease  runs  a  rapid  course.  The  acute  symptoms 
may  subside  in  a  few  hours.  The  attack  seldom  lasts  more  than 
twelve  hours.  Recovery  is  the  rule,  but  treatment  should  be  promptly 
applied. 

Treatment. — ^Apply  a  large  mustard  plaster  to  the  abdomen.  Give 
15  drops  of  laudanum.  If  the  dose  is  rejected  (immediately  vomited), 
try  it  again.  If  it  is  still  not  retained,  then  try  2  tablets  of  "  Sun 
Cholera  Mixture."  If  vomiting  quickly  occurs,  then  inject  into  the 
rectum  by  means  of  a  glass  or  rubber  syringe  about  20  drops  of 
laudanum  mixed  with  a  httle  thin  starch  or  a  Httle  water.  The 
rectal  injection  should  be  given  immediately  after  an  evacuation,  and 
the  patient  should  be  instructed  to  hold  it  as  long  as  possible.  In 
whatever  way  the  remedy  is  given  the  dose  should  be  repeated  in 
about  one  hour  if  the  vomiting  and  purging  continue. 

It  must  not  be  forgotten,  however,  that  aU  these  remedies  contain 
opium,  and  that  if  the  patient  is  inclined  to  sleep  or  shows  other  con- 
stitutional effect  of  the  drug  the  dose  must  not  be  repeated. 

The  nausea  and  thirst  may  be  controlled  by  cracked  ice  placed  in 
the  mouth.  Small  quantities  of  carbonated  water  may  be  allowed. 
If  the  thirst  is  very  urgent,  a  tablespoonful  of  iced  water  may  be 
given  at  short  intervals. 

COLIC. 

Intestinal  or  spasmodic  colic. — These  terms  are  appHed  to  abdom- 
inal pain  occuring  in  paroxysms  of  different  degrees  of  severity. 
The  pain  is  usually  referred  to  the  region  of  the  navel  or  middle 
of  the  belly.  It  may  be  due  to  indigestible  food,  cold  or  acid  drinks, 
poisons,  gases,  or  any  irritating  substance.  It  is  often  preceded  by 
obstinate  constipation.     Vomiting  frequently  occurs. 

Another  variety  of  cohc,  called  lead  colic  or  painter^s  colic,  is 
caused  by  lead  poisoning.  It  is  not  uncommon  in  painters  or  work- 
ers in  lead.  It  may  be  caused  by  drinking  water  taken  from  leaden 
pipes.  An  attack  may  be  mild  or  exceedingly  severe.  It  is  usually 
attended  by  obstinate  constipation  and  by  contraction  of  the  abdo- 
men. 

The  severe,  paroxysmal  pain  attending  the  passage  of  a  gallstone 
from  the  gaU.  bladder  to  the  intestine  is  called  biliary  colic.  In 
bihary  colic  the  pain  is  usually  most  marked  in  the  region  above  the 
navel  or  about  the  stomach  (epigastric  region).  The  paroxysms 
begin  and  end  suddenly.  Severe  nausea  and  vomiting  occur.  The 
skin  and  eyes  may  become  yellow  or  of  a  yellowish  hue  (jaundiced), 
the  same  as  in  bihous  coHc.  Gallstones  may  occasionally  be  found 
in  the  stools,  if  carefully  looked  for.  Some  cases,  however,  are 
difficult  to  distinguish  from  ordinary  intestinal  cohc. 


40  LIGHTHOUSE    SERVICE. 

The  severe,  excruciating  pain  caused  by  the  passage  of  a  small 
rough  stone  or  calculus  or  particles  of  sandy  substance  from  the 
kidney  through  the  ureter  to  the  urinary  bladder  is  called  nephritic 
colic,  kidney  colic,  or  an  attack  of  "the  gravel."  The  pain  usually 
begins  with  a  one-sided,  boring  backache.  Suddenly  it  increases  in 
intensity  and  shoots  down  the  loin  to  the  hip  and  thigh,  and  the 
patient  writhes  in  agony  until  the  ''stone"  or  particle,  sometimes 
not  larger  than  the  head  of  a  medium-sized  pin,  reaches  the  bladder, 
when  the  pain  suddenly  ceases.  The  paroxysm  may  last  from  half 
an  hour  to  a  number  of  hours,  or  one  or  two  days.  It  may  not  recur 
for  months  or  years;  on  the  other  hand,  there  may  be  two  or  more 
paroxysms  at  comparatively  short  intervals. 

Cohcky  pains  are  present  in  many  different  diseases.  Appendicitis 
frequently  begins  with  pain  not  unlike  that  of  intestinal  colic. 

Treatment. — If  the  colic  is  due  to  indigestible  food,  or  too  much 
food  of  any  kind,  an  emetic  should  be  given,  such  as  mustard  and 
water. 

After  the  stomach  is  emptied  give  a  teaspoonful  of  aromatic  spirits 
of  ammonia  in  water.  Apply  a  large  mustard  plaster  or  a  hot  poul- 
tice or  cloths  wrung  out  of  hot  water,  or  heat  of  any  kind  to  the 
abdomen.  (Local  applications  of  hot  water  usually  afford  some  relief 
in  any  variety  of  colic  or  wherever  pain  exists.)  If  the  cohcky  pains 
persist,  10  or  12  drops  of  laudanum  should  be  given  by  the  mouth, 
and  repeated,  if  necessary,  in  two  hours;  or  30  or  40  drops  of  lauda- 
num in  a  little  water  or  starch  may  be  injected  into  the  rectum. 

If  the  bowels  were  constipated  when  the  attack  began,  an  injection 
of  soap  and  warm  water  should  be  given  by  the  rectum,  or  small  doses 
of  Epsom  salts  or  castor  oil  may  be  given  by  the  mouth.  The  diet 
for  a  day  or  two  should  be  light  articles  in  small  quantities  at  a  time. 
The  treatment  for  lead  colic  is  about  the  same,  except  that  the  consti- 
pation should  be  reheved  at  once  by  full  doses  of  Epsom  salts  or  castor 
oil.  Apply  heat  to  the  abdomen  or  place  the  patient  in  a  warm  bath. 
Pressure  apphed  to  the  abdomen  affords  some  relief.  Kemove  the 
cause  or  remove  the  patient  from  the  cause  of  the  disease. 

In  biliary  colic,  the  bowels  should  be  freely  moved,  patient  should 
be  placed  in  a  hot  bath,  and  laudanum,  30  drops,  given  to  reheve  pain. 

In  nephritic  or  kidney  colic,  hot  baths  and  laudanum,  30  drops, 

are  the  remedies. 

APPENDICITIS. 

Appendicitis  is  an  inflammation  involving  the  appendix  vermi- 
formis.  This  is  a  small  attachment  of  the  large  intestine  situated  in 
the  right  groin.  It  may  begin  suddenly  with  violent  pains  in  the 
right  groin,  some  fever,  cohcky  pains,  nausea,  and  vomiting.  The 
seat  of  the  pain  is  usually  on  a  line  drawn  between  the  bony  promi- 
nence (the  large  bone  of  the  pelvis)  just  above  and  on  the  outer  side 


MEDICAL   HANDBOOK.  41 

of  the  right  groin  and  the  umbihcus.  As  the  attack  progresses,  that 
region  of  the  abdomen  may  become  hard  like  a  board  and  exceed- 
ingly sensitive  to  the  touch.  Often  you  will  find  that  the  patient 
flexes  the  right  leg  on  the  abdomen,  and  the  effort  to  straighten  it 
out  causes  him  great  pain.  Sometimes  the  attack  is  much  milder 
with  only  an  imeasy  sensation  in  the  right  groin,  very  sUght  fever, 
if  any,  and  a  sense  of  tenderness  over  the  part  affected.  This  pain 
may  be  in  the  pit  of  the  stomach  or  about  the  umbilicus. 

After  this  pain  has  been  present  for  a  few  days  a  swelUng  in  the 
right  groin  may  appear,  due  to  the  formation  of  pus  or  to  a  large 
protective  exudation  of  lymph. 

Treatment. — The  right  course  to  pursue  in  a  case  of  appendicitis 

is  to  call  in  a  surgeon.     If  the  services  of  a  surgeon  or  physician  can 

not  be  secured,  the  plan  of  treatment  should  be  as  follows:  Absolute 

rest  in  bed  with  an  ice  bag  over  the  appendix,  to  be  continued  during 

the  stage  of  severe  pain.     Do  not  give  purgatives.     Reduce  the 

allowance  of  food  and  drink  of  all  kinds  to  the  lowest  possible  limit. 

If  the  pain  is  very  severe,  20  drops  of  laudanum  in  a  little  water 

may  be  given  to  control  it.     If  the  bowels  move,  a  bedpan  should 

be  used,  and  under  no  circumstances  should  the  patient  be  allowed 

to  get  up. 

PILES. 

Piles  are  varicose  dilatations  of  the  veins  of  the  rectum.  The 
symptoms  may  be  slight  or  severe.  Inflamed  piles  are  very  painful. 
There  is  a  constant  burning  sensation  at  the  anus,  which  is  greatly 
increased  during  and  immediately  after  each  movement  of  the 
bowels.  When  the  veins  rupture  you  have  "  bleeding  piles. "  Occas- 
ionally the  inflammation  of  a  nodule  results  in  an  abscess. 

Treatment. — Piles  are  frequently  due  to  habitual  constipation,  and 
when  that  condition  is  improved  the  pUes  often  disappear,  or  at  least 
cease  to  be  troublesome.  The  bowels  should  be  kept  in  good  condi- 
tion. One  easy  movement  should  take  place  regularly  every  day. 
This  desirable  habit  should  be  brought  about  by  careful  attention  to 
diet  and  by  drinking  water  in  the  morning  before  breakfast  rather 
than  by  the  use  of  cathartics. 

In  acute  attacks,  if  the  bowels  are  constipated  give  a  full  dose  of 
Epsom  salts;  put  the  patient  on  light,  soft  diet.  Apply  ice  to  the 
anus  or  inject  cold  water  into  the  rectum.  A  hot  application  is 
sometimes  very  grateful.  If  the  piles  protrude,  especially  if  they 
become  strangulated,  they  should  be  pushed  back  with  the  finger; 
ohve  oil  or  petrolatum  may  be  applied.  If  the  piles  are  large  and 
persistently  painful,  see  a  surgeon  and  have  them  removed  by 
operation,  which  is  the  only  sure  cure. 


42  LIGHTHOUSE   SEEVICE. 

SCURVY. 

Scurvy  is  a  disease  produced  by  improper  or  unsuitable  food. 
Many  years  ago  it  was  of  frequent  occurrence  among  seafaring  men 
on  long  voyages.  Now  it  is  a  comparatively  rare  disease,  thanks  to 
better  provisions  and  better  methods  in  issuing  food  suppHes. 

Symptoms. — Swelling,  sponginess,  and  bleeding  of  the  gums.  The 
teeth  become  loose  and  frequently  drop  out.  The  breath  is  foul,  the 
tongue  swoUen.  The  skin  becomes  dry  and  scaly.  Hemorrhages 
(small  dark  red  spots)  occur  under  the  skin,  first  on  the  legs  and  then 
on  the  arms  and  other  parts  of  the  body.  Bleeding  from  the  nose 
frequently  occurs.  Swelling  about  the  ankles  is  common.  The  skin 
of  the  legs  is  frequently  discolored  in  large  blotches,  and  there  is 
often  a  pecuhar  hardness  or  induration  of  the  muscles  of  the  caK  of 
the  leg.  The  complexion  is  frequently  of  greenish  or  dirty-yellow 
hue.  The  pulse  is  rapid  and  weak.  There  may  or  may  not  be 
slight  fever.  The  bowels  may  be  constipated  or  there  may  be  a 
troublesome  diarrhea. 

In  severe  cases  debility  and  emaciation  are  quite  marked.  The 
mind  wanders,  and  occasionally  there  is  wild  dehrium. 

Treatment. — This  consists  almost  wholly  in  a  change  of  diet.  Give 
fresh  vegetables,  fresh  milk,  fresh  beef,  oranges,  lemons,  limes,  or 
lime  juice.  Begin  with  small  quantities  at  short  intervals,  and 
increase  the  allowance  as  rapidly  as  the  stomach  can  take  care  of  it. 
Pickles,  onions,  sauerkraut,  raw  potatoes,  and  raw  cabbage  are 
valuable  articles  in  the  make-up  of  a  varied  diet. 

Potassium  chlorate  dissolved  in  water  should  be  used  as  a  mouth 
wash,  and  the  gums  should  be  frequently  painted  with  tincture  of 
myrrh.  The  skin  should  be  kept  in  good  condition  by  frequent 
bathing.     The  sleeping  quarters  should  be  clean  and  well  ventilated. 

RHEUMATISM. 

There  are  different  forms  of  rheumatism  and  some  of  the  forms 
have  several  different  names.  Acute  rheumatism,  acute  articular 
rheumatism,  inflammatory  rheumatism,  and  rheumatic  fever  are 
terms  apphed  to  one  and  the  same  disease.  A  milder  form  of  the 
affection  is  called  subacute  rheumatism.  In  this  form  the  symptoms 
are  less  severe,  but  the  disease  is  more  prolonged.  It  may  continue 
for  a  long  time  and  become  chronic.  Chronic  rheumatism,  however, 
or  the  different  affections  and  deformities  of  joints  to  which  this 
term  is  frequently  applied,  may  develon  indenendently  of  any  acute 
or  subacute  attack. 

The  term  muscular  rheumatism  indicates  an  affection  of  the  mus- 
cles as  distinguished  from  joint  affections.  Lumbago  and  stiff  neck 
are  varieties  of  muscular  rheumatism.  The  muscles,  however,  to 
a  greater  or  less  extent  mav  be  involved  in  any  form  of  rheumatism. 


MEDICAL  HANDBOOK.  43 

Other  conditions  simulating  rheumatism,  occurring  in  connection 
with  or  directly  due  to  gonorrhea  or  to  syphilis,  are  called  gonor- 
rheal rheumatism  or  syphilitic  rheumatism,  as  the  case  may  be. 

Acute  rheumatism  (rheumatic  fever). — This  is  a  comparatively  com- 
mon disease  in  all  climates  within  the  Temperate  Zone.  It  occurs 
chiefly  during  the  winter  and  spring.  Exposure  to  a  cold,  damp  atmos- 
phere is  the  most  frequent  exciting  cause  in  persons  predisposed 
to  the  disease. 

It  may  or  may  not  begin  with  a  chill  or  with  a  sore  throat.  The 
larger  joints  are  usually  affected.  SweUing,  heat,  redness,  tender- 
ness, and  pain  are  the  chief  symptoms.  The  inflammation  is  apt  to 
shift  from  one  joint  to  another.  The  pain  and  fever  are  usuaUy 
increased  in  proportion  to  the  number  of  joints  involved.  The  ma- 
jority of  cases  are  attended  with  profuse  perspirations,  scanty,  highly 
acid  urine,  coated  tongue,  and  constipation.  The  heart  is  frequently 
involved. 

In  treating,  wrap  the  joint  in  cotton  or  flannel;  keep  it  very 
quiet — the  slightest  movement  aggravates  the  pain.  Flannel  wrung 
out  of  hot  water  and  applied  to  the  joint  sometimes  affords  relief. 
A  few  drops  of  oil  of  wintergreen  may  be  applied  on  a  piece  of  flannel 
if  the  pain  is  severe,  or  cold  apphcations  may  be  employed  if  agreeable 
to  the  patient. 

Place  the  patient  in  a  good  bed,  and  let  him  wear  flannel  next  to 
his  skin.  Change  the  flannel  frequently,  and  bathe  the  body  with 
tepid  water. 

For  internal  medication  give  salicylate  of  soda  in  doses  of  10  to 
15  grains  (0.6  gm.  to  1  gm.)  every  two  hours  until  about  eight  doses 
are  taken  or  the  pain  is  reheved,  then  give  it  in  smaller  doses  of 
from  3  to  5  grains  (0.2  gm.  to  0.3  gm.)  every  six  hours. 

The  food  should  be  soft  and  nourishing  and  given  every  three 
hours.  Epsom  salts  should  be  given  to  keep  the  bowels  open.  The 
patient  should  be  kept  in  bed  for  a  few  days  after  the  symptoms 
have  subsided.  The  duration  of  the  disease  is  very  uncertain.  The 
acute  symptoms  may  subside  in  a  few  days  and  the  patient  may  be 
up  and  about  in  a  week  or  10  days,  but  relapses  are  common,  and  the 
acute  may  pass  into  the  subacute  or  chronic  form. 

Chronic  rheumatism. — In  chronic  rheumatism  there  is  stiffness  and 
pain.  A  cracking  or  grating  sound  is  frequently  produced  when  the 
joints  are  suddenly  moved.  In  severe  cases  the  joints  become  enlarged 
and  distorted.     The  deformity  is  sometimes  very  great. 

The  treatment  consists  chiefly  in  local  apphcation  of  liniments, 
etc.,  which  afford  rehef  because  of  the  rubbing  (massage)  by  which 
they  are  applied.  Severe  pain  in  the  joint  may  be  relieved  by  cold 
applications  (flannel  wrung  out  of  iced  water,  apphed  to  the  jomt 


44  LIGHTHOUSE   SEEVICE. 

and  covered  with  muslin).     Hot  applications  to  the  joints  are  some 
times  of  value.     Belladonna  plaster  may  be  apphed. 

Five  to  eight  grains  (0.3  gm.  to  0.5  gm.)  of  potassium  iodide  in  a 
glass  of  water  may  be  given  three  times  a  day  between  meals. 

The  general  health  should  be  looked  after.  The  skin  should  be 
kept  in  good  condition  by  frequent  baths  of  tepid  water.  The 
bowels  should  be  moved  at  least  once  a  day.  Patient  should  be 
allowed  good  food.     Fresh  air  is  also  important. 

Muscular  rheumatism. — In  this  disease  the  muscles  most  frequently 
affected  are  those  of  the  back  (lumbago),  side  of  neck  (stiff  neck  or 
wry  neck),  and  side  of  chest  (pleurodynia).  Exposure  to  cold,  sudden 
coolmg  of  the  body — especially  after  active  exercise  and  sitting  in  a 
draft  of  air — are  the  chief  causes  or  exciting  causes. 

As  a  rule  there  are  no  symptoms  other  than  the  stiffness  and  pain 
on  motion.  The  muscles  may  be  shghtly  swollen  and  very  sensi- 
tive. Sometimes  the  attacks  come  on  suddenly  and  apparently  with- 
out cause,  or  following  a  shght  twist  or  strain,  as  a  "kink  in  the 
back,"  or  patient  may  wake  up  in  the  morning  with  a  stiff  neck. 

In  treating  acute  cases  sahcylate  of  soda  may  be  given  in  5  or 
10  grain  doses  (0.3  gm.  to  0.6  gm.)  every  three  hours  untU  four  or 
six  doses  are  taken.  Apply  hot  applications,  dry  heat,  hot-water 
bag,  or  a  hot  poultice  locally,  or  the  heat  may  be  apphed  by  a  flat- 
iron  over  folds  of  flannel  or  a  piece  of  blanket  and  the  rheumatism 
"ironed  out."  Later  apply  liniment  with  friction  (massage).  Keep 
the  affected  muscles  at  rest.  If  the  muscles  of  the  chest  are  affected, 
apply  strips  of  adhesive  plaster,  the  same  as  for  fractured  rib.  Acute 
attacks  are  of  short  duration,  but  relapses  are  not  uncommon, 'and 
chronic  forms  are  frequently  met  with.  Good  food,  fresh  air,  and 
attention  to  the  general  health  are  especiafly  important  in  the  treat- 
ment of  chronic  muscular  rheumatism. 

Gonorrheal  rheumatism  (gonorrheal  inflammation  of  joints). — This 
may  occur  during  an  acute  attack  of  gonorrhea,  but  it  is  more  frequently 
associated  with  chronic  gonorrhea  or  gleet.  One  or  several  joints 
may  be  affected.  There  may  or  may  not  be  considerable  fever.  If 
only  one  joint  is  affected,  it  is  apt  to  be  the  knee  or  the  ankle.  In 
chronic  cases  the  pain  is  sometimes  centered  in  the  heel.  The  attack 
may  begin  in  the  wrist,  elbow,  or  shoulder.  The  disease  is  not  always 
limited  to  the  joints.  Sometimes  the  inflammation  is  in  the  tissues 
outside  the  joint  proper,  in  the  sheaths  of  the  tendons  of  muscles, 
or  in  the  fascia  of  the  soles  of  the  feet.  The  swelling  is  frequently 
quite  marked.  In  chronic  cases  there  may  be  effusion  ("water  on 
the  joint").  In  very  severe  cases  suppuration  occurs  (abscess  forms). 
The  eye  and  the  heart  may  also  be  seriously  mvolved. 

Treatment  is  not  very  satisfactory.  Give  from  5  to  10  grains  (0.3 
gm.  to  0.6  gm.)  potassium  iodide  in  a  httle  water  between  meals. 


MEDICAL  HANDBOOK.  45 

Keep  the  joint  at  rest.  Apply  a  flannel  bandage.  Change  it  fre- 
quently and  wash  the  joint  with  hot  water  and  soap.  In  clironic 
cases  liniments  and  passive  motion  should  be  applied.  Tincture  of 
iodine  may  be  painted  over  the  joint.  A  few  drops  of  oil  of  winter- 
green  rubbed  gently  on  the  joint  before  the  apphcation  of  a  bandage 
will  often  allay  the  pain. 

Syphilitic  rheumatism. — This  so-called  rheumatism  is  associated 
with  secondary  or  tertiary  syphilis.  The  joints  and  the  shafts  of 
long  bones  may  be  affected — thickened  and  painful.  The  pain  is 
always  worse  at  night. 

The  treatment  is  by  potassium  iodide,  beginning  with  10  grains 
(0.66  gm.)  of  potassium  iodide  three  times  a  day  between  meals. 
Good  food  and  attention  to  the  bowels  are  important. 

SYPHILIS. 

Syphilis  is  a  constitutional  disease.  It  is  contagious,  or  commu- 
nicable, and  is  usually  acquired  during  sexual  contact.  It  may,  how- 
ever, be  contracted  in  many  different  ways,  direct  and  indirect.  It 
begins  by  a  primary  lesion  or  sore  called  a  chancre  at  the  seat  of  inoc- 
ulation (where  the  virus  enters),  and  is  followed  by  eruptions  of  the 
skin  of  different  forms  and  different  degrees  of  severity  and  variable 
duration.  Sores  also  appear  at  the  angle  of  the  mouth,  and  mucous 
patches  develop  on  the  lips,  tongue,  inner  sides  of  the  cheeks,  and 
sore  throat  is  very  common. 

Mucous  patches  or  syphilitic  warts  are  also  frequently  seen  about 
the  anus  or  in  any  region  where  the  skin  is  moist.  The  hair  fre- 
quently falls  out,  the  eyes  are  sometimes  seriously  involved,  and  sooner 
or  later  every  organ  in  the  body  may  become  affected.  A  man  suffer- 
ing from  syphiHs  in  active  form  should  not  be  allowed  to  go  on 
board  a  ship,  and  if  the  disease  breaks  out  while  on  the  voyage  he 
should  be  isolated,  or  at  least  be  compelled  to  use  separate  drinking 
cups,  knives,  spoons,  forks,  towels,  etc.  He  should  under  no  circum- 
stances smoke  the  pipe  belonging  to  another  man  nor  allow  another 
man  to  smoke  his.  All  his  belongings  should  be  kept  strictly  to 
himself,  for  unless  the  greatest  care  is  taken  other  men  of  the  crew 
will  suffer.  Chancre  of  the  lip  may  be  acquired  by  smoking  the  pipe 
of  a  syphihtic. 

The  primary  or  initial  lesion  of  syphilis  (the  hard  chancre)  usually 
appears  about  three  weeks  after  exposure,  but  may  be  as  early  as  10 
or  12  days  or  as  late  as  5  or  6  weeks.  It  begins  as  a  red  spot  or 
papule,  which  usually  breaks  and  forms  a  small  ulcer  with  hard 
edges;  sometimes  the  sore  appears  as  a  simple  excoriation  or  super- 
ficial ulcer  without  hard  edges.  The  neighboring  lymph  glands 
become,  in  the  course  of  a  week  or  two,  enlarged  and  hard.  They 
seldom  suppurate.     About  two  months  later  the  skin  eruption  and 


46  LIGHTHOUSE    SEEVICE. 

other  secondary  symptoms  begin.  The  lympli  glands  above  the 
elbow,  along  the  side  and  back  of  neck,  and  all  over  the  body  are 
usually  enlarged.  Patient  frequently  complains  of  headache  and 
pain  in  the  limbs,  always  worse  at  night,  and  may  have  slight,  occa- 
sionally considerable,  fever. 

Treatment. — For  the  primary  sore  bathe  the  part  with  soap  and 
water  and  dust  boric  acid  over  it  twice  a  day. 

If  secondary  symptoms,  eruptions  of  skin,  etc.,  appear,  give  a  pUl 
of  protiodide  of  mercury,  one-sixth  grain,  three  times  a  day.  Sal- 
vorsan  is  the  best  remedy  for  the  disease  but  this  medicine  can  only 
be  given  by  a  physician.  The  mouth  and  teeth  should  be  kept  clean 
by  means  of  a  soft  toothbrush  and  Castile  soap  and  water,  or  water 
to  which  a  small  quantity  of  bicarbonate  of  soda  (baking  soda)  or 
tincture  of  myrrh  has  been  added.  If  mucous  patches  appear  in 
the  mouth,  smoking  must  not  be  allowed.  If  on  board  ship,  as 
soon  as  the  ship  arrives  in  port  send  or  take  the  man  to  the  marine- 
hospital  office  and  receive  the  advice  of  a  surgeon  as  to  further 
treatment. 

SOFT  CHANCRE  (CHANCROID). 

Soft  chancre  or  chancroid  is  a  virulent  ulcer.  It  usually  begins 
within  36  hours  after  exposure,  first  as  a  red  spot,  but  rapidly 
developing  into  an  ulcer  covered  with  thick  yellowish  pus.  The 
period  of  development  is  about  3  or  4  days.  Sometimes  a  week 
elapses  from  the  time  of  exposure  to  the  development  of  the  sore, 
and  occasionally  a  period  of  incubation  is  as  long  as  10  days.  A 
sore  appearing  within  a  few  days  or  a  week  or  even  as  late  as  10 
days  after  the  exposure  is  usually  regarded  as  a  chancroid;  but  in 
practice  this  is  not  a  safe  rule,  for  the  reason  that  many  venereal 
sores  are  of  a  mixed  character.  The  inoculations  of  both  poisons  may 
take  place  at  the  one  and  same  spot — the  result  is  a  mixed  chancre;  or 
if  two  sores  appear,  the  origin  of  one  may  be  syphihtic,  the  other 
chancroidal.  It  is  therefore  difficult,  if  not  impossible,  in  many 
cases  to  determine  the  character  of  the  disease  from  the  period  of 
incubation  or  from  the  appearance  or  local  characteristics  of  the 
sore.  A  mixed  chancre  is  a  syphihtic  chancre  (a  hard  chancre), 
while  its  appearance  may  be  precisely  hke  that  of  the  soft  chancre  or 
chancroid.  The  only  safe  plan  is  to  regard  all  venereal  sores  as  sus- 
picious. But  while  this  is  true,  treatment  for  syphilis  should  not  be 
commenced  before  the  appearance  of  secondary  symptoms,  for  unless 
such  symptoms  appear  it  is  impossible  to  determine  that  syphilis 
really  exists  in  any  case.  The  mixed  chancre,  as  aheady  stated,  is 
essentially  a  syphilitic  chancre,  and  the  beginning  of  constitutional 
disease.  Its  local  effects,  however,  may  be  precisely  the  same  as  those 
of  soft  chancre  or  chancroid.     The  ulcer  (or  ulcers — sometimes  there 


MEDICAL   HANDBOOK.  47 

are  two  or  more)  may  remain  as  small  as  a  pea  or  grow  as  large  as 
a  quarter,  and  if  it  becomes  phagedenic  (eating)  may  spread  over  a 
large  surface  of  the  body.  It  is  also  proper  to  state  that  a  secondary 
syphilitic  sore  may  appear  under  the  foreskin,  as  well  as  at  any 
other  place  on  the  body,  and  that  cancer  (epithehoma)  of  the  organ 
may  begin  as  a  small  ulcer.  The  latter,  however,  is  a  rare  disease 
as  compared  with  the  different  varieties  of  chancre. 

The  most  frequent  complication  of  soft  chancre  or  chancroid  is 
inflammation  of  the  lymph  glands  of  the  groin  (bubo),  known  to 
the  sailor  as  ''blue  balls."  Another  troublesome  and  serious  com- 
phcation  is  the  elongation  and  contraction  of  the  orifice  of  the  fore- 
skin (phimosis),  on  the  inner  surface  of  which  the  sores  may  be 
located,  and  the  swelling  and  tension  may  be  so  great  as  to  pro- 
duce gangrene  (mortification).  If  the  foreskin  is  very  tight  and 
puUed  back  and  can  not  be  brought  forward  again,  the  condition 
is  known  as  paraphimosis,  which  produces  great  sweUing,  the  same 
as  if  a  string  were  tied  around  the  organ,  frequently  resulting  in 
severe  ulceration  and  destruction  of  tissue.  This  condition  may  also 
be  the  result  if  the  inflammation  and  swelling  are  marked  and  the 
foreskin  very  tight. 

The  sore  should  be  dried  and  covered  with  a  small  piece  of  aseptic 
gauze  or  absorbent  cotton,  and  later  a  dusting  powder  of  boric  acid 
may  be  applied. 

If  phimosis  exist,  the  cavity  of  the  foreskin  should  be  syringed 
out  with  hot  water,  and  if  there  are  sores  under  the  foreskin  which 
can  not  be  reached  by  the  acid  the  cavity  should  be  syringed  with 
a  solution  of  1  part  of  carbolic  acid  to  40  parts  of  water.  Soft 
chancres  or  chancroids  appearing  at  the  anus  or  rectum  should  be 
treated  by  frequent  washings  of  warm  water  and  the  apphcation  of 
calomel. 

In  aU  cages,  wherever  the  sore  is  located,  cleanliness  must  be  insisted 
upon,  and,  as  already  stated,  in  nearly  all  inflammations  of  whatso- 
ever character,  hot  water  alone  is  a  valuable  remedy;  and  rest  in  bed 
is  of  equal  importance.  If  a  lump  (bubo)  appear  in  the  groin,  rest  in 
bed  is  of  the  greatest  importance.  The  diet  should  be  light  but  nour- 
ishing. Tincture  of  iodine,  pure  or  diluted  one-haK  with  alcohol, 
may  be  painted  over  the  lump,  but  it  is  not  of  much  value.  Rest  is 
the  important  thing.  If  the  bubo  go  on  to  suppuration,  it  should  be 
carefully  opened  with  the  point  of  a  knife,  and  kept  open  by  a  strand 
of  aseptic  gauze,  which  must  be  frequently  changed,  and  enough 
aseptic  gauze  should  be  placed  on  top  of  the  wound  to  absorb  the 
discharges.  The  soiled  gauze  should  be  burned,  and  the  person 
handling  it  must  be  careful  to  wash  his  hands  in  soap  and  water  and 
in  one  of  the  antiseptic  solutions  already  referred  to.  The  patient's 
bowels  should  be  moved  once  a  day. 


48  LIGHTHOUSE    SEKVICE. 

GONORRHEA  (CLAP). 

Gonorrliea  is  a  specific  inflammation  of  the  urethra  due  to  a  micro- 
organism, called  gonococcus.  It  usually  begins  during  the  first  week 
after  exposure,  sometimes  as  early  as  3  or  4  days,  and  occasionally 
as  late  as  10  days  or  2  weeks.  The  first  symptoms  are  a  tickling  or 
itching  sensation  and  a  slight  swelling  about  the  lips  of  the  orifice 
of  the  urethra.  A  purulent  creamy-colored  discharge  soon  appears, 
and  a  burning  or  stinging  pain  attends  the  passage  of  urine.  The 
inflammation  graduaUy  extends  to  the  deeper  parts  of  the  urethra, 
and,  unless  checked  by  medication,  reaches  its  height  about  the 
end  of  the  second  or  during  the  third  week.  The  patient  may  ex- 
perience great  difficulty  in  passing  water.  If  the  inflammation  run 
very  high,  abscesses  may  form  in  the  tissues  around  the  urethra,  and 
swelled  testicle  and  bubo  are  frequent  comphcations ;  also  painful 
erections  and  bending  of  the  organ  (chordee).  Phimosis  or  para- 
phimosis occurs  if  the  foreskin  is  tight  or  becomes  involved  in  the 
inflammation. 

If  phimosis  occur,  and  if  the  cavity  of  the  foreskin  is  not  thor- 
oughly and  frequently  washed  out,  "venereal  warts"  are  apt  to  form. 

True  gonorrhea,  if  carefully  treated,  graduaUy  subsides  and  recov- 
ery may  take  place  in  from  four  weeks  to  two  months.  A  urethral 
discharge  that  recovers  in  a  few  days  or  a  week  is  probably  a  simple 
urethritis. 

Gonorrhea  is  urethritis  (inflammation  of  the  urethra),  but  ure- 
thritis is  not  necessarily  gonorrhea. 

Treatment. — Rest  in  bed,  light  diet,  plenty  of  water  to  drink, 
regularity  in  eating  and  sleeping.  '  Keep  the  bowels  open  by  taking 
a  moderate  dose  of  Epsom  salts  in  the  morning.  Avoid  strong  coffee 
and  tea,  aU  stimulants,  and  greasy  articles  of  food.  Keep  the  body 
and  mind  at  rest.  Batli  frequently  in  hot  water.  Be  very  careful 
not  to  carry  any  of  the  pus  from  the  urethra  to  the  eyes.  (Gonor- 
rheal inflammation  of  the  eyes  is  a  very  serious  disease,  which  not 
infrequently  results  in  total  bhndness  and  loss  of  the  eyes.) 

Give  a  copaiba  capsule  three  times  a  day.  If  much  pain  in  the 
back  or  over  the  region  of  the  kidneys  follow  the  use  of  the  copaiba, 
it  must  be  discontinued  for  a  time  or  the  dose  lessened. 

Injections  of  argyrol  10  parts,  water  90  parts;  permanganate  of 
potash  1  part,  water  5,000  parts;  or  sulphate  of  zinc  1  grain,  water 
1  ounce,  into  the  urinary  canal  may  be  used.  They  should  be  em- 
ployed as  follows:  The  patient  first  passes  his  water,  the  urinary 
canal  is  then  washed  out  with  several  syringes  full  of  warm  water. 
One  of  the  above  solutions  is  then  injected  slowly  into  the  canal  and 
held  there  5  minutes  by  the  watch.  The  best  syringe  for  this  pur- 
pose is  one  made  of  glass,  having  a  plunger  wrapped  with  cotton 
thread. 


MEDICAL    HANDBOOK.  49 

If  the  chordee  is  troublesome,  apply  cloths  wrung  out  of  cold 
water, 

A  snug  suspensory  bandage  worn  from  the  begmnmg  may  prevent 
the  complication  of  swelled  testicles.  If  the  patient  is  lying  in  bed, 
the  dragging  of  the  testicles  should  be  prevented  by  placing  them  on 
a  support.  The  best  local  remedy  for  swelled  testicles  is  heat,  which 
may  be  applied  by  pieces  of  cloth  or  flannel  wrung  out  of  hot  water. 

STRICTURE  OF  THE  URETHRA. 

True  or  organic  stricture  of  the  urethra  is  a  narrowing  of  the  tube. 
It  is  commonly  the  result  of  long-continued  or  neglected  gonorrhea. 
Stricture  of  the  urethra  may  be  produced  by  direct  injuries,  as  kicks 
or  falls  on  the  perineum,  or  by  the  use  of  too  strong  injections,  or  by 
the  careless  passage  of  instruments. 

Occasionally  stricture  results  from  simple  urethritis,  not  gonor- 
rheal, and  sjrmptoms  not  unlike  those  of  stricture  are  sometimes 
caused  by  a  stone  in  the  bladder  obstructing  the  passage,  and  by  an 
enlarged  prostate  gland. 

Gonorrheal  stricture  of  the  urethra  is  usually  of  slow  development. 
It  may  be  several  months  or  years  after  the  attack  of  gonorrhea 
before  the  patient  becomes  conscious  of  any  change  in  the  size  or 
shape  of  the  stream.  First  there  may  be  only  a  twisting  or  flattening 
of  the  stream.  In  severe  cases  it  gradually  becomes  smaller  and 
smaller,  until  it  is  no  larger  than  a  knitting  needle  and  passed  with 
great  difficulty,  or  it  comes  away  drop  by  drop,  and  finally  results 
in  complete  retention.  One  of  the  earhest  symptoms  of  stricture  is 
a  gleety  discharge  from  the  urethra. 

Occasionally  retention  of  urine  is  the  first  symptom  of  the  disease. 

Sudden  retention  may  be  due  to  spasm  of  the  urethra  (spasmodic 
stricture) , 

Spasmodic  stricture  may  occur  independently  of  any  specific  dis- 
ease of  the  urethra,  but  it  is  more  frequently  a  comphcation  of  organic 
stricture.  Exposure  to  cold  and  wet  (catching  cold),  or  a  debauch, 
are  the  usual  exciting  causes. 

When  retention  occurs  the  bladder  gradually  becomes  distended 
and  a  fullness  or  distinct  tumor  may  be  felt  in  the  lower  part  of  the 
abdomen,  which  in  severe  cases  may  extend  as  high  as  the  navel. 
Sometimes  there  is  an  involuntary  flow,  or  an  overflow  of  urine  from 
a  distended  bladder — patient  says  he  can  not  hold  his  water,  and  in 
such  case  it  may  be  difficult  to  convince  him  that  he  is  suffering  from 
retention,  until  a  catheter  is  passed  and  a  quantity  of  urine  is  with- 
drawn. 

Treatment. — A  neglected  stricture  of  the  urethra  is  a  serious  dis- 
ease, the  treatment  of  which  is  very  difficult  in  many  cases,  even  in. 
the  hands  of  the  most  experienced  surgeon. 

98908°— 15 4 


50  LIGHTHOUSE   SEKVICE. 

If  a  case  is  allowed  to  run  on  until  there  is  an  actual  stoppage  or 
retention  of  urine,  unless  this  condition  is  reUeved  the  consequences 
are  extremely  serious  and  death  may  be  the  result. 

Place  the  patient  on  his  back  with  his  knees  shghtly  drawn  up, 
and  try  to  pass  a  catheter.  The  instrument  should  first  be  thoroughly 
cleansed  by  placing  it  in  boiling  water.  It  should  then  be  oiled  with 
oHve  oil,  and  carefully  passed  into  the  urethra  and  effort  made  with 
the  greatest  gentleness  to  pass  into  the  bladder.     (Fig.  1.) 

Try  the  largest  size  catheter  first;  if  this  fail,  try  the  smaller  ones. 
If  a  catheter  can  not  be  passed  at  the  first  trial,  place  the  patient  in 

a  hot  bath,  give  him  20  drops  of 
laudanum,  and  an  hour  or  two 
later  try  the  catheter  again.  If  it 
is  not  practicable  to  place  the 
patient  in  a  full  bath  of  hot  water, 
then  cover  his  beUy  and  other 
parts  of  his  body  with  flannels 
wrung  out  of  hot  water  and  change 
them  every  15  minutes.  The  ob- 
'^n^g^gjjpp'  .^    £  ^-|^    hot  bath  and  the  laud- 

FiG.  1.— How  to  use  catheter;  shows  the  curve  of      J  ^ 

the  channel  through  which  the  catheter  must      aUUm    is     tO     produCC    relaxation. 

P^-  Sometimes  a  patient  will  pass  his 

water  in  the  bath.  If,  however,  the  symptoms  are  very  urgent,  if 
the  patient  can  not  pass  any  water,  and  after  the  most  careful  and 
gentle  manipulation  the  catheter  can  not  be  passed  into  the  bladder, 
the  services  of  a  surgeon  should  be  secured. 

VENEREAL  PROPHYLAXIS. 

Venereal  disease  may  often  be  prevented  in  men  by  the  applica- 
tion of  calomel  ointment  after  intercourse.  The  ointment  must  be 
used  within  1  hour  after  the  man  has  subjected  himself  to  infection. 
It  may  possibly  be  efficacious  after  3  hours,  but  the  longer  the  time 
that  has  elapsed  before  the  prophylactic  is  employed,  the  greater  the 
danger  of  contracting  the  disease.  The  ointment  should  be  well 
rubbed  into  the  skin  of  the  penis  and  scrotum,  and  a  small  portion 
should  be  injected  into  the  urethra.  Small  packages  containing  this 
ointment  are  now  put  up.  A  short  tube,  attached  to  one  end  of  the 
package,  is  for  insertion  into  the  urethra.  No  one  should  use  a  pack- 
age belonging  to  another  for  fear  of  carrying  disease  from  one  person 
to  another.  The  ointment  should  not  be  allowed  to  remain  on  the 
skin  over  6  hours,  as  it  may  cause  irritation.  It  should  be  removed 
by  soap  and  hot  water,  after  which  a  dusting  powder  should  be 
applied. 


FIRST  AID  TO  THE  INJURED. 


RULES  TO  BE  OBSERVED  IN  TIME  OF  ACCIDENT. 

1.  Give  the  patient  air, 

2.  Lay  the  patient  down,  head  lower  than  the  body. 

3.  Rip  the  clothes  off  the  injured  part. 

4.  In  removing  a  coat  or  shirt,  first  release  the  good  arm,  then  the 
injured  one. 

5.  Turn  the  head  to  one  side  to  allow  vomited  matters  to  escape 
from  the  mouth. 

6.  Do  not  give  whisky  to  the  patient.  If  he  can  swallow,  and 
needs  a  stimulant,  give  coffee,  tea,  hot  milk,  or  hot  water. 

7.  Then  follow  directions  given  elsewhere  in  this  book. 

BLEEDING  (HEMORRHAGE). 

Kinds  of  blood  vessels. — There  are  two  kinds  of  blood  vessels. 
Those  that  carry  the  blood  from  the  heart  to  all  parts  of  the  body 
are  called  arteries.  The  blood  in  them  is  bright  red,  and  escapes 
in  jets  or  spurts  corresponding  to  each  beat  of  the  heart.  Bleeding' 
from  these  is  more  dangerous  and  more  difficult  to  control,  as  a  rule, 
than  bleeding  from  the  vessels  that  return  the  blood  to  the  heart. 
Fortunately,  however,  the  larger  arteries  in  the  Umbs  lie  near  the 
bones,  and  are  consequently  well  protected  in  most  parts  by  the  mass 
of  muscles  covering  them.  The  vessels  that  return  the  blood  to  the 
heart  are  veins.  They  contain  a  darker  blood,  and  when  cut,  the 
blood  escapes  in  a  steady  stream,  not  in  spurts.  While  the  largest 
veins  in  the  limbs  are  also  near  the  bones,  there  are  some  of  con- 
siderable size  just  under  the  skin. 

If  we  should  desire  to  stop  a  stream  of  water  flowing  past  a  given 
point,  we  would  naturally  go  upstream  from  that  point  and  not 
downstream  to  adopt  the  necessary  measures.  In  bleeding  from 
an  artery — the  blood  coming  from  the  heart — the  artery  must  be 
compressed  at  a  place  between  the  heart  and  the  bleeding  point.  On 
the  other  hand,  if  a  vein  is  bleeding — the  blood  flowing  toward  the 
heart — pressure  must  be  made  on  the  vein  at  a  place  farther  from 
the  heart  than  the  bleeding  point. 

Bleeding,  general  treatment. — Before  begimiing  the  treatment  of 
any  wound  or  any  bleeding  point,  the  operator  must  carefully  cleanse 
his  hands  and  arms,  also  the  wound  and  surrounding  parts,  and  the 
instruments  and  sUk  ligature  should  be  boiled,  as  described  under  the 
head  of  wounds. 

51 


52 


LIGHTHOUSE   SERVICE. 


In  the  after  treatment  of  severe  bleeding  the  patient  should  be 
kept  perfectly  quiet  in  mind  and  body,  his  head  should  be  lowered  by 
raising  the  foot  end  of  his  bed  or  bunk.  Give  him  plenty  of  fresh 
air,  but  keep  his  body  warm  and  give  him  hot  drinks.  After  reaction 
the  temperature  of  the  body  may  rise  a  degree  or  two  above  normal, 
but  if  this  should  continue  longer  than  two  or,  at  most,  three  days, 
the  dressing  should  be  removed  and  the  wound  thoroughly  irrigated, 
first  with  hot  water,  then  with  a  solution  of  bichloride  of  mercury 
(1  to  5,000),  and  dressed  with  aseptic  gauze. 

Bleeding  from  arteries. — There  are  certain  places  in  the  body 
where  the  arteries  are  not  covered  by  much  muscle,  and  can  be  easily 


Fig.  2. 


Fig.  3. 


compressed  against  bone.  These  places  are  shown  m  the  illustra- 
tions. The  bleeding  should  first  be  controlled  by  thumb  pressure 
at  the  pomts  indicated  in  the  illustrations,  and  if  the  services  of  a 
doctor  can  be  secured  without  delay,  this  will  be  all  that  is  necessary 
until  he  arrives.  If  there  is  any  doubt  as  to  the  exact  place  at  which 
pressure  should  be  made,  a  slight  shifting  of  the  thumb  from  one 
point  to  another  should  be  rapidly  made,  and  when  the  bleeding  stops 
it  indicates  that  the  proper  location  has  been  reached  and  pressure 
should  be  continuous  at  this  point.  If  a  doctor  is  not  within  reach, 
the  bleeding  must  of  course  be  controlled  by  some  other  device. 
When  the  bleeding  is  from  one  of  the  limbs,  and  some  distance  from 
the  body,  a  bandage  or  clean  handkerchief  should  be  wrapped  around 
the  limb  at  the  point  indicated  in  the  illustration,  and  drawn  tight 
enough  to  stop  the  bleeding.  The  "Spanish  windlass"  (figs.  2  and  3) 
is  made  by  knotting  a  handkerchief  aromid  the  limb  loosely,  passing 


MEDICAL   HANDBOOK.  53 

a  stick  through  the  slack  part,  and  taking  up  the  slack  by  twisting 
the  handkerchief.  To  prevent  untwisting,  the  stick  is  then  bound 
to  the  limb  by  one  or  two  other  bandages  or  handkerchiefs.  A  smaU 
round  stone,  a  cork,  or  other  similar  object  placed  in  the  folds  of  the 
handkerchief  and  lying  directly  over  the  vessel  will  assist.  Only 
sufficient  pressure  should  be  made  to  barely  stop  the  bleeding  The 
windlass  must  be  loosened  every  20  minutes  to  give  a  chance  for  the 
Hfe  blood  to  flow  through  the  part  as  there  is  great  danger  of  gan- 
grene (mortification)  if  the  blood  is  entirely  shut  off  for  longer  than 
this  time. 

The  knot  in  the  windlass  should  not  be  untied,  and  the  stick 
should  be  left  m  position  for  immediate  tightenmg  if  the  blood  again 
begins  to  flow  freely.  If  the  windlass  is  to  be  used  for  several  hours, 
it  is  best  to  encircle  the  limb  with  a  folded  towel  before  applying  it, 
as  there  is  less  danger  of  injuring  the  skin  and  soft  parts.  If  the  bleed- 
ing artery  is  in  or  near  the  body,  where  a  windlass  can  not  be  apphed, 
thumb  pressure  must  be  kept  up  until  the  doctor  arrives,  one  person 
relieving  another.  The  second  person's  thumb  should  gradually  push 
the  first  person's  thumb  aside,  and  thus  prevent  a  spurt  of  blood.  In 
exceptional  cases  it  may  be  necessary  to  place  the  thumb  directly 
in  the  wound  to  control  the  bleeding,  but,  no  matter  how  clean  the 
thumb  may  be,  this  should  only  be  resorted  to  in  desperate  cases,  as 
there  is  great  danger  of  infecting  the  wound.  Reference  is  made  in 
this  connection  to  the  chapter  on  antiseptics. 

In  places  where  the  services  of  a  physician  can  not  be  obtained 
the  wound  should  be  stretched  open,  the  blood  vessel  located,  seized, 
and  drawn  gently  forward  with  a  pair  of  artery  forceps  and  the  ends 
tied  with  heavy  thread  that  has  been  boiled  for  five  minutes.  If 
artery  forceps  can  not  be  obtained,  take  a  needle  or  a  bent  pin,  pass 
it  through  a  flame  several  times,  hook  onto  the  vessel,  and  draw  it 
out;  then  tie  it  tightly  with  the  thread  described  above.  If  a  httle 
flesh  is  tied  in  the  knot  with  the  artery,  this  wOl  be  of  no  conse- 
quence. After  the  artery  has  been  securely  tied  the  "Spanish  wind- 
lass" should  be  removed,  or,  if  thumb  pressure  has  been  employed, 
this  should  be  discontinued.  The  wound  should  then  be  closed  as 
described  under  the  heading  "Wounds." 

Bleeding  from  veins. — The  deep  veins  as  a  rule  follow  closely  the 
course  of  the  arteries.  If  thumb  pressure  on  the  far  side  (the  side 
farthest  from  the  heart)  of  the  bleeding  point  fails  to  control  the 
bleeding,  a  Spanish  windlass  should  be  applied  on  the  far  side.  If 
the  bleeding  vein  is  near  the  surface,  it  may  be  possible  in  some  cases 
to  control  it  by  a  windlass  with  a  stone  or  cork,  the  windlass  not 
being  drawn  tight  enough  to  shut  off  the  deeper  vessels.  In  some 
cases  bleedmg  from  veins  is  best  controlled  by  pressure  dhectly 
over  the  bleeding  point,  but  the  thumb  should  be  covered  by  a  clean 


54 


LIGHTHOUSE   SEEVICE. 


Fig.  4. 


cloth,  such  as  a  handkerchief  or  towel.     Elevation  of  the  part  and 
removal  of  all  constricting  bands,  such  as  garters,  will  assist. 

Where  there  is  simply  an  oozing 
of  blood  and  it  does  not  appear 
that  any  vessel  of  size  has  been  sev- 
ered the  case  can  frequently  be  con- 
trolled by  steady  pressure  on  the 
bleeding  surface.  Sometimes  cloths 
soaked  in  water  as  near  the  boiling 
point  as  can  be  borne  and  constantly 
changed  will  accomphsh  the  result. 
If  peroxide  of  hydrogen  is  at  hand, 
it  is  one  of  the  best  known  agents 
to  stop  simple  oozing. 

Bleeding  from  head  and  face. — 
Reference  to  figure  4  will  show  a 
■  point  infront  of  the  ear,  compression 
upon  which  will  control  bleeding  about  the  temple.  Another  im- 
portant point  for  pressure  is  shown  where  the  artery  crosses  the  edge 
of  the  lower  jawbone.  This  controls  bleeding  in  the  parts  supphed  by 
this  artery,  as  shown  in  the 
illustration.  If  the  bleed- 
ing is  severe  and  it  is  evident 
that  a  larger  and  deeper  ves- 
sel is  responsible,  it  is  neces- 
sary to  compress  the  large 
artery  in  the  neck.  If  you 
will  tm"n  your  own  head  well 
toward  one  shoulder,  say 
the  right,  you  will  be  able  to 
feel  a  strong  muscle  stand- 
mg  out  under  the  skin  and 
extending  from  a  point  just 
back  of  the  ear  to  the  point 
where  the  left  coUar  bone 
joins  the  breastbone.  This 
is  your  guide  to  the  deep 
artery.  Pressure  should  be 
made  deeply  between  the  lower  end  of  this  muscle  and  the  windpipe, 
compressing  the  artery  directly  against  the  backbone  (figs.  5  and  6). 
Bleeding  from  shoulder. — If  the  bleeding  is  in  the  neighborhood 
of  the  shoulder  joint,  the  artery  to  be  controlled  is  the  one  lying 
directly  under  the  collar  bone.  Pressure  is  made  downward  behind 
the  collar  bone,  near  the  point  where  it  joins  the  breastbone,  the  ai'tery 
being  compressed  against  the  rib  (figs.  5  and  7). 


Fig.  5. 


MEDICAL  HANDBOOK. 


55 


Bleeding  from  arm,  forearm,  and  hand. — If  you  will  place  your 
left  hand  on  your  right  arm  between  the  shoulder  and  elbow  and  then 


Fig.  6. 


Fig.  7. 


bend  the  right  elbow  and  straighten  it  out  several  times,  you  will 
feel  a  muscle  swell  up  in  the  arm  and  subside  again.     Extending 


Fig.  8. 


along  the  inner  edge  of  this  muscle  and  close  to  the  bone  a  large 
artery  can  be  felt  beating  (figs.  8  and  9).  This  is  the  one  to  compress 
when  bleeding  is  from  a  point  in  the  arm  or  forearm.     If  in  the  fore- 


56 


LIGHTHOUSE    SERVICE. 


Fig.  10. 


arm,  the  best  place  to  compress  tliis  last-mentioned  artery  is  just 
above  the  elbow;  and  this  is  also  the  best  point  if  there  is  severe 
bleeding  in  the  hand. 

Bleeding  from  thigh  or  leg. — In  the  groin,  halfway  between  the 
hip  bone  and  the  middle  line  of  the  body,  the  main  artery  supplying 
the  thigh  and  leg  can  be  pressed  against  the  bone 
(fig.  10).  If  the  bleecHng  is  from  the  back  of  the 
knee,  the  leg,  or  foot,  the  best  place  to  apply 
pressure  is  just  above  the  knee  at  the  back  of 
the  thigh  (fig.  11). 

Bleeding  from  lungs  and  stomach. — If  the 
blood  is  from  the  lungs  it  is  generally  coughed 
up  and  has  the  bright  red  appearance  of  ordi- 
nary blood.  If  from  the  stomach,  the  acid  of 
the  stomach  juice  changes  the  blood  until  it  has 
more  the  appearance  of  coffee  grounds.  If,  how- 
ever, the  bleeding  is  severe,  the  vomited  blood 
may  be  bright  red,  as  the  acid  of  the  stomach 
may  not  have  had  time  to  act  upon  it.  Some- 
times blood  brought  into  the  throat  from  the 
lungs  is  swallowed  by  the  patient  and  later  vom- 
ited in  its  changed  condition. 
In  the  treatment  of  either  of  these  conditions,  it  is  best  to  keep 
the  patient  very  quiet  in  bed,  let  him  suck  small  pieces  of  ice  in 
Hmited  quantity,  and  apply  cracked  ice  in  some  waterproof  covering 
over  the  chest  or  pit  of  the  stomach,  as  the  case  may  be.  Moral 
encouragement  and  cheerfulness  on  the  part  of  the  at- 
tendants are  very  necessary. 

Bleeding  from  the  nose. — If  bleeding  of  the  nose 
occur  in  a  full-blooded  person,  especially  if  such  person 
is  subject  to  dizziness,  we  should  not  be  in  too  much  of 
a  hurry  to  stop  it.  But  if  the  bleeding  is  the  result  of 
injury  or  if  it  occur  in  a  person  suffering  from  disease 
of  the  heart  or  lungs  or  from  the  effects  of  malarial 
fever,  scurvy,  or  any  disease  of  the  general  system, 
effort  should  be  made  to  stop  it.  Nosebleed  from  a 
blow,  in  a  healthy  individual,  usually  stops  in  a  short 
time  without  any  particular  treatment.  If  it  does  not 
stop,  place  a  piece  of  paper  folded  to  the  thickness  of  a 
quarter  of  an  inch  well  up  between  the  upper  lip  and 
gum,  and  compress  the  lip  tightly  against  it.  The 
main  blood  vessels  supplying  the  nose  pass  upward  from 
the  corners  of  the  mouth  to  the  sides  of  the  nose,  and  this  paper 
tends  to  compress  the  vessels  and  shut  off  the  blood  supply.  The 
patient  should  lie  on  his  back  with  his  head  on  a  pillow.  If  ice  is 
obtainable,  it  should  be  cracked  into  small  pieces,  wrapped  in  a  thin 


Fig.  11. 


MEDICAL  HANDBOOK.  57 

cloth,  and  placed  over  the  nose,  sufficient  being  used  to  cover  the 
whole  surface.  Cold  applied  to  the  back  of  the  neck  will  also  do 
good  in  some  cases.  If  the  bleeding  is  obstinate,  a  strip  of  gauze  or 
soft  cloth  can  be  pushed  gently  into  the  nostrils,  the  ends  being 
allowed  to  hang  out. 

Bleeding  from  the  urinary  canal. — This  is  usually  caused  by  fall- 
ing astride  of  a  hard  object.  The  bleeding  may  be  profuse,  but  is 
usually  controlled  by  pressure  with  a  folded  towel.  If  the  bleeding 
is  severe,  a  stick  with  a  crosspiece  at  one  end  should  be  placed  at  the 
foot  of  the  bed,  the  crosspiece  pressing  against  the  towel  in  the  crotch. 
After  the  bleeding  ceases,  the  patient  should  be  kept  very  quiet  and 
cold  applications  should  be  applied. 

BROKEN  BONES  (FRACTURES). 

There  are  many  varieties  of  fracture.  A  fracture  is  said  to  be 
simple  where  there  is  no  open  wound  directly  over  the  bone  injury; 
compound  when  there  is  an  opening  in  the  skin  and  soft  parts  extend- 
ing down  to  the  broken  bone;  comminuted  when  the  bone  is  broken 
in  several  places;  complicated  when  associated  with  other  injuries,  as 
dislocation  of  the  joint  or  rupture  of  the  main  artery  of  the  limb; 
impacted  when  one  fragment  is  driven  into  another. 

SIMPLE  FRACTURES. 

In  a  typical,  well-marked  fractiu-e  of  a  bone  in  one  of  the  limbs 
we  will  find  the  following : 

1.  History  of  an  injury. 

2.  Pain  and  tenderness,  and  later  swelUng;  and  sometimes  dis- 
coloration of  the  part. 

3.  Deformity,  in  some  cases. 

4.  Shortening,  due  to  the  fact  that  in  most  cases  the  break  is 
obliquely  across  the  bone  and  the  fragments  override. 

5.  Scraping  noise,  called  crepitus,  when  the  ends  of  the  bones  are 
rubbed  together. 

6.  Inability  or  disuiclination  to  use  the  part. 

Any  of  these  signs  may  be  absent  in  a  given  case.  Sometimes  it 
is  impossible  to  tell  without  an  X-ray  examination  whether  we 
have  to  deal  with  a  fracture,  a  spraia,  or  a  bruise,  but  in  such  cases 
it  is  always  best  to  assume  that  we  have  a  fracture  to  treat 

In  transverse  fracture,  where  the  break  is  straight  across  the  bone 
at  a  right  angle  with  the  long  axis  of  the  bone,  or  in  a  fracture  near 
a  joint,  there  may  be  no  shortening  and  no  deformity.  In  fractures 
of  certain  bones,  as  the  skuU  or  the  spine,  or  in  an  impacted  frac- 
ture, there  may  be  no  motion.  In  fracture  of  the  kneepan  or  the 
elbow  the  fragments  are  pulled  apart  by  the  muscles,  so  there  is 
lengthening  instead  of  shortening. 


58  UGHTHOUSE   SEEVICE. 

Examination  should  always  be  made  as  soon  as  possible  after  the 
accident.  Under  the  most  favorable  circmnstances  it  is  difficult 
in  some  cases  to  determine  whether  a  bone  is  broken  or  not,  and  the 
difficulty  is  greatly  increased  if  the  examination  is  delayed  until 
inflammatory  swelling  has  set  in.  In  fractures  of  the  extremities 
the  sound  Hmb  should  always  be  placed  alongside  the  injured  one  for 
comparison.  The  shortening  in.  fracture  of  the  thigh  may  be  from 
1  to  3  inches,  but  it  must  not  be  forgotten  that  in  some  persons  there 
is  a  natural  difference  of  as  much  as  half  an  inch  in  length  of  the 
pair  of  legs;  and  a  limb  may  be  otherwise  naturally  deformed  which 
should  not  be  mistaken  for  accidental  deformity.  In  the  leg  below 
the  knee  there  are  two  parallel  bones  (tibia  and  fibula).  In  simple 
fracture  affecting  only  one  of  these  bones  the  deformity  and  crepitus 
are  less  marked;  and  the  same  may  be  said  of  the  forearm,  if  frac- 
ture exists  in  only  one  of  the  bones  (radius  or  ulna).  If  both  bones 
of  the  leg  (tibia  and  fibula)  or  of  the  arm  (radius  and  ulna)  are 
affected,  there  may  be  considerable  deformity,  and  it  is  a  curious 
fact  that  fracture  of  these  bones  seldom  occurs  on  the  same  level. 
The  distance  between  the  fractures  may  be  from  1  to  3  inches,  usually 
greater  in  the  leg  than  in  the  forearm. 

Crepitus  (the  sound  heard  or  feeling  imparted  to  the  hand  when 
the  broken  ends  of  the  bone  are  rubbed  together)  is  a  valuable  symp- 
tom of  fracture,  but  it  can  not  always  be  detected,  and  when  other 
marked  signs  or  symptoms  are  present  need  not  and  should  not  be 
looked  for.  In  fractures  of  the  leg  below  the  knee  or  of  the  forearm, 
involving  only  one  of  the  bones,  it  is  hard  to  make  out  because  of  the 
difficulty  of  rubbing  the  broken  ends  together,  and  when  much  swell- 
ing exists  the  difficulty  is  increased,  or  a  false  crepitus  may  be  pro- 
duced. In  impacted  fractures,  which  occur  chiefly  in  the  neck  of  the 
thigh  bone,  no  effort  should  be  made  to  obtain  crepitus.  The  impor- 
tant thing  in  such  cases  is  not  to  disturb  the  impacted  fragments,  for 
if  pulled  apart  recovery  is  rendered  more  difficult. 

Treatment. — This  can  best  be  described  by  taking  as  an  example 
a  fracture  of  both  bones  in  the  middle  of  the  leg.  The  object  of  the 
treatment  is  to — 

1.  Set  the  bone  (known  as  reducing  the  fracture). 

2.  Apply  some  dressing  that  wiU  hold  the  broken  pieces  of  bone 
in  position. 

3.  Watch  for  sweUing,  and  see  that  the  bandages  are  not  too 
tight. 

In  handling  a  broken  leg,  or  one  in  which  a  broken  bone  is  sus- 
pected, the  leg  should  always  be  stretched  by  grasping  it  above  and 
below  the  fracture  point.  This  prevents  deformity,  injury  to  the 
blood  vessels,  nerves,  and  soft  parts  by  the  sharp  ends  of  the  bones, 
and  causes  the  patient  less  pain.  If  a  patient  with  a  broken  leg  is 
to  be  placed  on  a  bed,  one  or  two  boards  should  be  passed  under  the 


MEDICAL   HAl^DBOOK. 


59 


springs  of  the  bed  from  side  to  side  to  prevent  sagging,  as  this  would 
cause  displacement  of  the  bones  and  pain  to  the  patient.  One 
person  grasps  the  foot  firmly,  with  both  hands  placed  over  the  instep 
and  heel,  respectively,  and  pulls  down,  while  another  person  grasps 
the  thigh  just  above  the  knee  with  both  hands  and  pulls  in  the  oppo- 
site direction.  While  the 
leg  is  thus  extended  and 
the  attention  of  the  two 
assistants  is  directed  solely 
to  this  injured  leg,  other 
persons  pick  up  the  patient 
carefully  and  transfer  him 
to  the  bed.  If  a  doctor  can 
be  reached  in  a  compara-  fig.  12. 

tively  short  time,  the  leg  can  be  held  in  position  by  means  of  sandbags. 
The  two  legs  of  a  pair  of  overhauls  cut  off,  filled  with  sand  or  heavy 
earth,  and  tied  at  the  ends,  when  placed  along  either  side  of  the  leg 
will  answer  the  purpose.  The  broken  leg  is  approximately  in  proper 
position  when  the  ball  of  the  great  toe,  the  inner  ankle,  and  the  inside 
of  the  knee  are  in  the  same  verticle  plane ;  in  other  words,  if  a  board 
were  placed  on  edge  along  the  inside  of  the  leg,  the  three  points  men- 
tioned would  all  touch  the  board. 

If  the  patient  is  to  be  transported  to  the  doctor,  or  if  some  time 
wiU  elapse  before  the  doctor  can  arrive,  the  leg  must  be  incased  in 
some  dressing  that  will  hold  it  stiff  and  not  aUow  the  broken  bones 
to  move.  Any  dressing  applied  for  this  purpose  should  be  well 
padded  with  cotton,  soft  underclothing,  moss,  or  anything  that  is 

available.  Particular  atten- 
tion should  be  paid  to  the 
ankle,  the  heel,  and  also  the 
parts  near  the  break  to  see 
that  they  are  aU  well  cush- 
ioned. A  piece  of  heavy- 
pasteboard  moistened  can  be 
molded  fairly  weU  to  the  leg. 
Sometimes  a  pillow,  partic- 
ularly a  hair  pillow,  if  sup- 
ported by  strips  of  wood  on  the  outside  to  prevent  it  bending,  can 
be  used.  The  dressing  is  bound  to  the  limb  with  bandages.  These 
may  be  made  by  tearing  up  a  sheet,  pillowcase,  shirt,  or  blanket. 

The  toes  should  not  be  inclosed  in  the  dressing,  because  if  the 
doctor  can  not  be  reached  in  a  short  time,  it  is  necessary  to  watch 
the  toes  to  determine  whether  the  swelling  has  made  the  dressing 
too  tight.  If  the  toes  are  bluish  and  cold,  the  bandages  should  be 
loosened  to  let  the  blood  circulate.  If  plaster  of  Paris  or  cement 
is  at  hand,  the  old  Bavarian  splint  (figs.  12,  13,  and  14)  can  be 


60  LIGHTHOUSE   SERVICE. 

liiade  by  a  layman.  Take  two  pieces  of  blanket  as  long  as  the 
lower  leg  and  18  inches  wide.  Fold  each  piece  in  the  center  along 
its  long  dimension  and  sew  these  folds  together,  as  shown  in  the 
illustration.  Place  the  leg  on  the  seam,  bring  the  upper  fold  on 
either  side,  and  let  the  two  surround  the  leg,  trimming  off  the  blanket 
so  that  the  edges  simply  come  together  but  do  not  lap.  Now  smear 
the  wet  plaster  of  Paris  or  cement  over  this  layer,  and  then  bring 
up  the  other  layer  around  the  leg,  trim  it  in  the  same  manner,  and 
tie  the  dressing  on  with  several  bandages  until  it  "sets."  This 
kind  of  a  splint  can  be  opened  at  any  time  for  examination  of  the 
leg,  the  seam  at  the  back  acting  like  the  hinge  of  a  clam  shell.  Pos- 
sibly wet  clay  could  be  used  in  such 
a  dressing  if  the  limb  could  be  placed 
before  a  fire  to  dry. 

The  necessary  thing  in  all  first-aid 
work  is  to  get  the  principles  firmly 
fixed  in  the  mind,  and  human  inge- 
nuity will  find  a  way  of  carrying  out 
these  principles.  A  box  can  be  con- 
structed to  incase  the  limb,  it  being 
properly  padded.  Wliatever  dress- 
ing is  applied,  if  the  patient  is  to 
be  moved  any  distance,  it  is  best  to  make  the  dressmg  long  enough 
to  cover  the  joints  above  and  below  the  fracture  and  thus  prevent  the 
bones  movmg,  as  there  will  then  be  less  danger  of  displacing  them 
and  the  patient  will  be  more  comfortable.  If  the  bandage  is  rolled 
loosely  and  stirred  about  in  a  vessel  of  thick  starch,  it  can  then  be 
applied  hot,  and  when  dry  forms  an  excellent  stiff  dressing;  but  such 
a  bandage  should  not  be  stretched  while  being  applied  because  the 
starch  contracts  in  drying  and  the  dressing  wiU  be  too  tight.  A 
starch  dressing,  after  drying,  can  be  slit  up  along  the  front  leg  to 
loosen  it,  and  then  held  in  position  by  several  bandages. 

COMPOUND  FRACTURES. 

Compound  fractures  are  serious  accidents  and  require  prompt 
attention.  The  general  principles  of  treatment  so  far  as  the  bone 
is  concerned  (place  it  in  normal  position  and  keep  it  there)  are  the 
same  as  for  simple  fracture.  But  to  do  this  and  at  the  same  time 
give  proper  attention  to  the  wound  in  the  soft  parts  (the  open  wound 
extending  down  to  the  bone)  frequently  demands  the  highest  surgical 
skill. 

Shock  from  loss  of  blood  is  the  immediate  danger.  Inflammation, 
erysipelas,  blood  poisoning,  or  lockjaw  may  set  in  later,  and  still  later 
the  patient  may  become  exhausted  from  long-continued  suppuration. 


MEDICAL   HANDBOOK.  61 

Treatment. — If  the  wound  is  very  small  it  should  be  well  cleaned 
with  hot  water  (water  that  has  been  raised  to  the  boihng  point  and 
allowed  to  cool  down  to  about  120°  F.)  or  by  antiseptic  solution 
(solution  bichloride  of  mercury  1  to  5,000),  then  covered  with  aseptic 
gauze,  and  the  case  treated  as  a  simple  fracture.  (Clean  hands  as 
indicated  on  p.  96.) 

In  nearly  all  cases,  however,  the  safest  and  best  plan  is  to  leave 
the  wound  uncovered  by  splint  or  bandage,  so  that  hght  dressings 
may  be  easily  applied  and  frequently  changed.  The  wound  should 
be  thoroughly  cleansed  with  hot  water  and  antiseptic  solution  before 
reducing  the  fracture,  for,  if  dirt  on  the  end  of  the  bone  or  skin  is 
drawn  into  the  wound  when  the  bone  is  returned  to  its  proper  place, 
infection  with  organisms  causing  lockjaw  or  other  dangerous  condi- 
tions may  occur,  by  which  the  patient  may  lose  his  limb  or  his  life. 
The  splints  or  extending  apparatus  should  be  so  arranged  that  the 
wound  is  freely  accessible  and  easily  drained.  Strips  of  aseptic 
gauze  should  be  placed  in  the  wound  and  gently  carried  down  to  the 
bottom  by  means  of  a  probe,  and  a  larger  piece  of  aseptic  gauze  in 
loose  folds  should  be  laid  over  the  wound. 

The  aseptic-gauze  dressing  should  be  renewed  every  day  or  every 
second  day  or  as  often  as  necessary  to  keep  the  wound  well  drained 
until  it  heals  from  the  bottom. 

In  severe  cases  amputation  may  be  necessary  to  save  life,  and  in 
all  cases  the  patient  should  be  placed  under  the  care  of  a  surgeon  as 
soon  as  possible. 

FRACTURE  OF  THE  LOWER  JAW. 

Fracture  of  the  lower  jaw  may  be  simple,  compound,  or  com- 
minuted. The  mucous  membrane  of  the  mouth  is  nearly  always 
lacerated,  the  bleeding  is  usually  not  severe  (oozing  only),  but  there 
may  be  hemorrhage  from  an  artery  (the  inferior  dental),  saliva  drib- 
bles from  the  half-open  mouth,  the  teeth  may  be  out  of  line,  pain  is 
apt  to  be  severe,  there  may  be  considerable  deformity  and  a  false 
point  of  motion. 

Treatment. — ^Restore  the  parts  to  the  natural  position  and  keep 
them  at  perfect  rest,  first  washing  out  the  mouth  with  hot  water  to 
cleanse  it  and  check  bleeding.  If  the  bleeding  is  very  severe,  pressure 
should  be  made  by  the  thumb  or  finger  for  a  time  on  the  bleeding 
point,  if  possible,  or  on  the  large  artery  (carotid)  on  the  side  of  the 
neck,  which  may  be  easily  located  by  the  pulsation.  Loose  teeth  or 
pieces  of  bone  should  not  as  a  rule  be  removed.  Mold  them  into 
place,  bring  the  teeth  and  jaw  into  natural  Hne,  and  keep  them  so  by 
a  pasteboard  or  binder's  board  sphnt,  held  in  place  by  a  four-tailed 
bandage,  as  described  under  bandaging. 


62  LIGHTHOUSE   SERVICE. 

If  the  parts  can  not  be  kept  in  place  by  the  methods  described,  the 
teeth  may  be  fastened  together  with  silver  wire  passed  between  the 
teeth  on  each  side  of  the  break  and  twisting  the  ends  together.  Feed 
the  patient  on  hquid  food  through  a  rubber  tube  introduced  behind 
the  last  tooth  or  through  any  space  left  by  the  loss  of  a  tooth,  the 
object  being  to  prevent  movement  of  the  jaw.  Wash  out  the  mouth 
frequently  with  hot  water,  and  if  necessary  change  the  dressing 
every  two  or  three  days  until  the  end  of  about  the  sixth  or  eighth 
week,  when,  if  aJI  goes  well,  union  will  be  complete,  and  the  splint  and 
bandage  may  be  discontinued. 

FRACTURE  OF  THE  NOSE. 

If  the  nose  is  broken  and  it  is  possible  to  reach  a  doctor  within  four 
or  five  days,  it  is  best  for  the  layman  not  to  attempt  to  restore  the 
bones  to  position.  If,  however,  there  is  great  depression  of  the  nose, 
and  a  doctor's  services  can  not  be  obtained  for  a  long  time,  a  very 
gentle  effort  may  be  made  to  lift  the  bones  into  position  by  passing 
into  the  nostrils  a  thin  stiff  piece  of  metal  well  wrapped  with  some  soft 
material.  When  the  patient  can  breathe  weU  through  either  nostril 
while  the  other  nostril  is  held  closed,  it  is  an  indication  that  the  bones 
are  in  fairly  good  position.  The  operation  described  is  a  technical 
procedure  and  should  not  be  attempted  by  a  layman  except  in  an 
extreme  case  where  medical  assistance  can  not  be  obtained. 

FRACTURE  OF  THE  SKULL. 

If  the  skull  is  fractured,  there  may  be  unconsciousness,  paralysis, 
bleeding  from  the  nose  or  ears,  or  other  unusual  manifestations.  It 
is  important  to  get  the  doctor  as  soon  as  possible.  In  the  meantime, 
it  is  a  very  good  general  rule  in  this,  as  well  as  in  all  first-aid  work,  to 
keep  the  patient's  head  cool  and  the  feet  warm.  If  ice  is  at  hand, 
an  ice  cap  can  be  made  by  tying  up  the  broken  ice  in  a  piece  of  mackin- 
tosh, odcloth,  rubber  sheeting,  or  other  waterproof  material  that  wiU 
keep  the  patient  from  getting  wet.  Warmth  to  the  feet  and  body  can 
be  applied  by  hot  water  in  bottles  or  jugs,  or  by  heating  plates,  stones, 
or  bricks  in  water  and  wrapping  them  well.  Remember  always  that 
an  imconscious  man  or  one  seriously  injured  can  not  tell  his  wiUuig 
helpers  when  a  thing  is  too  hot,  and  due  care  should  be  exercised. 
Do  not  pour  whisky  down  the  patient's  throat.  If  he  is  able  to 
swallow,  he  probably  does  not  need  a  stimulant;  and  if  he  can  not 
swallow,  the  whisky  wiU  choke  him.  In  many  cases,  the  first  resort 
of  the  layman  is  the  whisky  bottle,  and  when  the  doctor  arrives  he 
can  not  tell  how  much  of  the  stupor  is  due  to  the  whisky  and  how 
much  to  the  injury. 

If  it  is  impossible  to  obtain  the  services  of  a  physician  for  several 
days,  care  should  be  taken  to  see  that  the  patient  passes  his  urine.  If 
no  urine  is  voided  for  24  hours  after  the  injury,  a  hot  pack  of  towels, 


MEDICAL   HANDBOOK.  63 

wrung  out  of  hot  water,  should  be  placed  over  the  bladder;  the  pack 

must  not  be  too  hot  or  the  patient  may  be  burnt.     If  this  does  not 

have  the  desired  effect,  a  soft  rubber  catheter,  if  one  is  obtainable,  after 

being  boiled  for  five  minutes,  should  be  carefully  introduced  into  the 

urinary  canal  and  the  urine  drawn  off.     Before  taking  this  step,  the 

person  who  has  charge  of  the  patient  should  thoroughly  cleanse  his 

own  hands  and  carefully  wash  the  genital  organs  of  the  patient  with 

soap  and  water. 

BROKEN  BACK. 

If  the  back  is  broken,  there  is  usually  paralysis  of  the  lower  limbs, 
and  sometimes  the  patient  passes  the  urine  and  contents  of  the 
bowels  involuntarily. 

Special  care  should  be  taken  to  prevent  bedsores.  The  bed  should 
be  as  comfortable  as  it  is  possible  to  make  it.  A  rubber  sheet  should 
be  placed  over  the  mattress  and  the  bed  linen  should  be  changed 
frequently.  The  back  and  buttocks  should  be  kept  clean  by  frequent 
washing  with  soap  and  water.  The  skin  should  then  be  dried  with  a 
soft  towel,  bathed  with  a  mixture  of  equal  parts  of  alcohol  and  water, 
and  then  dusted  over  with  starch.  If  the  skin  becomes  red,  zinc 
ointment  should  be  applied. 

At  other  times  the  patient  may  pass  no  urine  and  then  it  has  to  be 
drawn,  as  described  under  the  previous  heading. 

The  mind  may  be  perfectly  clear  and  the  patient  as  a  rule  suffers 

no  pain. 

FRACTURE  OF  RIBS. 

Fractures  of  the  ribs  are  sometimes  difficult  to  determine,  but  if 
present,  there  will  usually  be  a  stitchlike  pain  upon  taking  a  deep 
breath;  and  if  the  chest  is  c^uickly  compressed  by  one  hand  on  the 
breastbone  and  the  other  on  the  backbone,  the  patient  may  complain 
of  pain  at  the  point  where  the  bone  is  broken,  usually  somewhere  under 
the  armpit.  As  spliuts  can  not  be  applied  to  a  part  like  this,  and  as 
the  ribs  are  constantly  moving  in  breathing,  the  best  that  can  be 
done  in  the  way  of  first  aid  is  to  strap  the  injured  side  with  strips  of 
sticking  plaster  2  or  3  inches  wide,  long  enough  to  reach  from  the 
middle  line  in  front  or  a  little  beyond  to  the  middle  line  behind  or 
farther,  the  strips  lapping  over  one  another,  drawn  rather  tightly, 
and  extending  from  the  lowest  ribs  well  up  into  the  armpit.  In  the 
absence  of  sticking  plaster  a  strip  of  muslin  12  inches  wide,  passed 
around  the  chest  rather  tightly  several  times  end  snugly  pinned,  will 
give  some  comfort  until  the  doctor  arrives. 

FRACTURE  OF  THE  THUMB  AND  FINGERS. 

Treatment. — Put  the  fragments  in  place  by  extension  and  pressure; 
then  cut  a  piece  of  pasteboard,  leather,  cigar  box,  or  thin  board  long 
enough  to  extend  from  above  the  wrist  joint  to  a  httle  below  the  ends 


64 


LIGHTHOUSE   SERVICE. 


Fig.  15. 


of  the  fingers  and  a  little  wider  than  the  hand.     Cover  the  board  with 

lint  or  any  soft  cloth,  place  the  palm  of  the  hand  flat  upon  it,  and 

apply  a  bandage  around  the  whole  hand  and  wrist. 

If  pasteboard  or  leather  be  used,  it  may  first  be  dipped  into  hot 

water  and  then  molded  to  the  shape  of  the  thumb  or  fiLiiger  and  palm 

of  the  hand,  then  lined  or  covered 
with  cloth,  and  bandaged  as 
above,  care  being  taken  not  to 
make  the  bandage  too  tight. 

FRACTURE  OF  THE  FOREARM. 

The  forearm  extends  from  the 
wrist  to  the  elbow.  When  both 
bones  are  broken  there  is  apt  to 
be  marked  displacement  and 
crepitus  (grating  felt  by  rubbing 
the  broken  ends  of  the  bone  to- 
gether). When  only  one  bone  is 
broken  the  signs  and  symptoms 
are  not  so  clear,  but  by  careful 
examination  the  nature  of  the  mjury  may  be  determined.  When 
fracture  of  one  of  the  bones  (the  radius)  occurs  near  the  wrist  joint 
(Colles'  fracture)  there  is  generally  marked  deformity  resembhng 
a  silver  fork  in  shape. 

In  fracture  of  the  forearm  take  a  thin  board  3^  inches  wide,  and 
long  enough  to  reach  from  the  elbow  to  the  tips  of  the  fingers  (fig.  15). 
After  stretching  the 
forearm  by  grasping  the 
hand  and  the  arm  above 
the  elbow  until  it  seems 
fairly  straight,  lay  the 
palm  side  of  the  forearm 
and  hand  on  the  board, 
well  padded,  and  place 
on  the  back  of  the  fore- 
arm and  hand   another 

similar  padded  board  extending  from  the  elbow  to  the  knuckles. 
Carefully  and  evenly  bandage  the  splints,  starting  at  the  fingers 
and  working  up.  Leave  the  tips  of  the  fmgers  uncovered  to  watch 
the  circulation  (fig.  16).  The  bandaged  arm  can  be  carried  in  a  sling. 
Another  way  to  hold  the  splints  in  place  is  to  apply  strips  of  adhe- 
sive plaster  around  them,  one  at  the  upper  and  the  other  at  the  lower 
end.  If  swelling  occurs,  the  bandage  must  be  loosened.  The  splints 
should  be  worn  six  weeks  or  two  months,  and  passive  motion — that  is, 
gently  bending  and  straightening  of  the  fingers  with  the  other  hand — ■ 
must  be  made  every  few  days  to  prevent  stiffening. 


Fig.  16. 


MEDICAL   HANDBOOK.  65 

FRACTURE  OF  THE  ARM  (BETWEEN  THE  ELBOW  AND  SHODXDER). 

Treatment. — In  a  break  of  the  upper  arm  it  is  well  to  make  two 
gutters  of  moistened  pasteboard,  and  apply  them  after  padding  to 
the  outside  and  inside  of  the  arm.  The  entire  arm  and  forearm 
should  then  be  supported  by  two  angular  splints  (figs.  15  and  17) 
made  of  thin  board,  one  applied  from  the  fingers  to  the  armpit,  the 
other  from  the  fingers  to  the  shoulder.  The  padding  should  be 
especially  heavy  and  even  about  the  elbow  and  any  other  place 
where  the  bones  naturally  come  near  the  skin. 

If  much  swelling  occurs,  aU  bandages  must  be  loosened. 


Fig.  17. 


The  splint  should  be  worn  about  eight  weeks.  Under  the  most 
favorable  circumstances,  after  fracture,  this  bone  (the  humerus) 
sometimes  fails  to  unite.  At  least  once  a  week  the  joints  should  be 
moved  to  prevent  stiffness. 

Fractures  of  the  arm  (of  the  humerus)  at  or  near  the  elbow  joint 
or  shoulder  joint  are  frequently  very  difiicult  to  make  out,  even  by 
the  most  skillful  surgeon,  especially  if  some  time  has  elapsed  since 
the  injury  was  received;  and  the  treatment  of  necessity  is  equally 
difficult. 

If  near  or  at  the  elbow  joint,  and  if  there  is  much  pain,  heat,  and 
swelling,  as  is  apt  to  be  the  case,  cold  applications  should  be  applied, 
and  the  arm  laid  upon  a  pillow  until  the  swelling  has  gone  down.  A 
08908°— 15 5 


66 


LIGHTHOUSE    SEKVICE. 


rectangular  splint  of  binder's  board  or  leather  should  then  be  dipped 
in  hot  water  and  appHed  to  the  inner  side  of  the  arm  and  forearm. 
The  splint  should  be  wide  enough  to  extend  nearly  haKway  around 


Fig.  is. 


Fig.  19. 


the  arm.     It  must  be  weU  padded  and  held  in  place  by  a  roller  band- 
age, and  the  forearm  supported  by  a  sling. 

If  the  break  is  near  the  shoulder  joint,  the  dressing  can  be  supple- 
mented by  shtting  a  piece  of  pasteboard  at  one  end,  moisterdng  it, 
and  molding  it  to  form  a  shoulder  cap  (figs.  18,  19,  and  20),  which 
is  bound  in  place  by  passing  bandages  from 
the  injured  shoulder  around  the  body  and  op- 
posite shoulder. 

After  the  application  of  any  apparatus  for 
fracture  of  the  arm  or  forearm,  the  circulation 
should  be  carefully  watched  by  feelmg  the  pulse 
at  the  wrist.  If  it  can  not  be  felt,  or  if  the 
fingers  swell,  the  bandages  should  be  removed 
and  reapplied  less  tightly. 

FRACTURE  OF  COLLAR  BONE. 

The  collarbone  connects  the  breastbone  to  the 
shoulder.  Childi'en  may  have  a  green-stick 
fractm^e  in  which  this  bone  is  not  completely 
broken  across.  In  adults  the  fracture  is  nearly  always  a  simple 
one,  the  bones  overriding.  The  shoulder  drops  downward  from  its^ 
own  weight,  and  is  drawn  inward  and  forward  by  the  muscles. 
The  first-aid  indications  are  therefore  to  overcome  these  actions 


MEDICAL    HANDBOOK. 


67 


as  far  as  possible,  and,  to  force  the  shoulder  upward,  outward,  and 
backward.  Placing  the  arm  in  a  sling  will  draw  the  shoulder  upward 
to  a  certain  extent,  and  this  can  be  assisted,  if  sticking  plaster 
is  available,  by  placing  the  hand  of  the  injured  side  on  the  oppo- 
site shoulder,  and  then  binding  it  there  by  placing  the  middle  of 
a  long  strip  of  2  or  3  inch  stickuig  plaster  under  the  elbow,  one 
end  passing  along  the  forearm  to  the  hand  on  the  shoulder  and  the 
other  end  passing  diagonally  across  the  back  to  meet  the  first  end 
on   the  shoulder.     Other  strips   of  sticking   j)laster  or   a  bandage 


Fig.  21.  Fig.  22. 

passed  around  the  injured  shoulder,  then  across  the  back,  and 
fastened  around  the  body,  will  force  the  shoulder  backward  and  to  a 
slight  extent  outward,  and  make  the  patient  more  comfortable  until 
the  doctor  arrives.  In  the  absence  of  sticking  plaster  a  bandage 
applied  in  a  '^figure  of  eight"  may  hold  the  shoulders  in  fairly  good 
position  (figs.  21  and  22).  Stand  at  the  patient's  back,  pass  the 
bandage  over  one  shoulder  to  the  front,  then  under  the  armpit 
to  the  back,  across  the  back  to  the  front  of  the  opposite  shoulder, 
through  this  armpit  to  the  starting  point  on  the  back.  Go  over 
the  route  several  times  with  some  tension  on  the  bandage,  and  then 
make  the  end  fast. 

FRACTURE  OF  THE  THIGH. 

The  thigh  bone  (femur)  extends  from  the  hip  to  the  knee.  Frac- 
ture of  this  bone  may  occur  in  any  portion  of  the  shaft,  but  the  most 
common  seat  of  fracture  is  about  the  middle  or  the*  middle  thu'd. 


68 


LIGHTHOUSE    SEPAT:CE. 


Fractures  higli  up  near  the  hip  jomt  are  frequently  very  diflGicult  to 
make  out,  and,  the  results  of  treatment  m  such  cases,  even  under  the 
care  of  skillful  surgeons,  are  not  always  satisfactory. 

In  fracture  of  the  middle  or  middle  third  of  the  bone,  the  deform- 
ity is  usually  produced  by  the  lower  fragment  (the  broken  end  of 
the  lower  portion  of  the  bone)  being  drawn  up  behind  and  to  the 
inner  side  of  the  upper  fragment;  the  weight  of  the  limb  then  causes 
rotation  and  the  foot  and  toes  are  turned  outward. 

If  the  fracture  is  a  little  higher  up,  displacement  is  shown  by  the 
upper  fragment,  which,  by  the  action  of  the  muscles,  is  thrown 
strongly  forward  and  outward.  In  either  case  there  are  complete 
loss  of  power,  shortening  to  the  extent  of  1  to  2  or  3  inches,  pain  on 
the  slightest  movement,  crepitus  (grating)  if  the  broken  ends  of  the 
bone  are  rubbed  together,  and  abnormal  motion. 

In  impacted  fractures,  which  are  met  chiefly  at  or  near  the  hip 
joint,  the  shortening  may  be,  and  usually  is,  less  marked.  Loss  of 
power  is  usually  complete,  but  not  always.  Patients  have  been 
known  to  stand  and  even  walk  a  few  steps.  Injuries  of  this  kind 
require  the  greatest  care ;  the  limbs  should  be  handled  very  carefully. 


Fig.  23. 


If  on  slight  traction  or  manipulation  crepitus  is  not  felt,  no  further 
attempt  should  be  made  to  obtain  this  symptom,  for'in  doing  so  the 
impacted  bones  may  be  pulled  apart,  which  is  to  be  avoided  unless 
especially  directed  by  a  skillful  surgeon. 

Treatment. — In  the  absence  of  a  physician,  about  all  that  may 
reasonably  be  expected  to  be  done  m  impacted  fracture  is  to  apply 
a  broad  bandage  aromid  the  hips  and  place  the  patient  in  a  good  bed 
on  a  firm  mattress  and  make  lateral  support  by  means  of  boards 
(fig.  23),  or  by  sandbags,  one  on  the  outside  long  enough  to  reach 
from  the  upper  end  of  the  hip  bone  to  the  foot,  the  other  along  the 
inner  side  of  the  leg  from  the  crotch  to  the  foot.  Fill  the  bags  three- 
quarters  full  of  dry  sand.     Keep  the  leg  straight,  toes  upward. 

Treatment  of  nonimpacted  fracture  of  the  thigh  bone  at  or  near 
the  hip  joint. — Place  both  legs  on  the  double-inclined  plane,  or  make 
extension  and  fix  the  limb  in  the  straight  position  by  means  of  a  long 
splint  (a  sphnt  extendmg  from  the  armpit  to  the  foot),  or  by  the, 
weight  and  pulley,  or  by  the  long  splint  and  the  weight  and  pidley 
combined,  in  the  manner  now  about  to  be  explained  in  connection 
with  the  treatment  of  fractures  of  the  shaft  of  the  thi^h  bone» 


MEDICAL    HANDBOOK. 


69 


Treatment  of  fractures  of  the  shaft  of  the  thigh  bone. — In  frac- 
ture of  the  shaft  of  this  bone  the  signs  and  symptoms,  as  aheady 
stated,  are  usually  well  marked.  If  the  fracture  is  at  the  upper  end 
or  in  the  upper  third  of  the  bone,  especially  if  the  upper  fragment  is 
tilted  forward,  the  double-inclined  plane   (fig.  24)  well  padded  or 


Fig.  24. — Shows  a  double-inclined  plane  with  the  weight  and  pulley — 1  is  the  double-inclined  plane,  2  and 
3  are  circular  pieces  of  adhesive  plaster  to  prevent  4,  the  longitudinal  strip  on  each  side  of  the  thigh,  from 
slipping;  5  and  6  are  the  pulley  and  weight. 

covered  with  pillows,  with  weight  and  pidley  attached  by  means  of 
adhesive  plaster  stuck  to  each  side  of  the  thigh  as  far  as  the  knee, 
afi'ords  the  easiest  and  probably  the  best  means  of  treatment.  But 
in  the  majority  of  cases  when  the  fracture  is  farther  down,  about  the 
middle  or  in  the  middle  third  of  the  bone,  the  weight  and  pulley  with 


Fig.  25. — Shows  the  weight  and  pulley  applied  with  the  leg  and  thigh  in  the  straight  position — the  adhesive 
strips  being  attached  to  the  leg  as  well  as  the  thigh. 

the  leg  and  thigh  m  a  straight  Ime  (fig.  25),  or  the  weight  and  pul- 
ley and  long  splint  combined  (fig.  26)  are  better  adapted  if  properly 
appHed.  Sandbags  may  also  be  used  in  connection  with  any  of  the 
straight  splints  placed  alongside.  In  all  cases  the  fracture  should  be 
reduced  by  gradually  pulhng  and  carefully  pressing  the  broken  bones 
into  their  natural  position.     In  addition  to  the  sphnts  already  men- 


70 


LIGHTHOUSE    SEEVICE. 


tioned,  short  splints  of  narrow  strips  of  thin  board  or  binder's  board 
should  be  applied  directly  over  the  seat  of  fracture. 

If  a  double-inclined  plane  is  not  at  hand,  two  broad  pieces  of 
board  may  be  nailed  together  at  a  suitable  angle  and  used  instead, 
always  properly  padded  or  covered  with  pillows. 

The  weight  and  pulley  (figs.  25  and  27). — The  weight  and  pulley 
are  apphed  as  follows:  Measure  the  distance  from  1  inch  below  the 


Fig.  26.— Shows  the  long  lateral  splint  extending  from  the  armpit  to  a  point  a  little  below  the  foot.    It  is 
bandaged  to  the  body  and  the  lower  extremity,  and  may  be  used  with  the  weight  and  pulley. 

crotch  to  a  point  4  inches  below  the  foot.  Cut  a  strij)  of  adhesive 
plaster  exactly  twice  as  long  as  the  distance  just  measured  and  3 
inches  wide,  and  stretch  it  on  a  table  or  on  the  floor,  with  the 
sticky  side  up.  Get  a  block  of  wood  4  inches  long,  about  3  inches 
wide,  and  about  one-half  iuch  thick,  with  a  hole  bored  through  the 
center  large  enough  to  admit  a  large  cord.  Place  the  block  exactly 
in  the  center  of  the  long  strip  of  adhesive  plaster.     Cut  another  strip 


Gl 


I   C  0. 


Fig.  27. — A  shows  the  long  strip  of  adhesive  plaster;  B  shows  the  short  strip.  Cis  the  block  of  wood 
4  by  3  by  J  inches  with  a  hole  in  the  center.  B  shows  the  block  placed  between  the  two  strips  of 
plaster,  all  ready  for  application  to  the  leg  or  thigh. 

of  plaster  the  width  of  the  first  and  18  inches  long,  and  place  it 
on  the  fhst  strip,  sticky  surfaces  together,  so  as  to  include  the  block 
between  the  center  of  each.  Thus  a  stirrup  is  made  and  the  plaster 
kept  from  sticking  to  the  ankle  bones,  because  it  would  make  them 
sore.  The  long  strip  of  plaster  on  each  side  of  the  stirrup  is  then 
apphed  to  the  leg  and  thigh  after  shaving  on  each  side  the  surface 
to  which  it  is  to  be  apphed,  extendmg  from  a  point  just  above  the 
ankle  bone  to  a  point  about  1  mch  below  the  crotch  on  the  mner 
side  and  to  the  same  level  on  the  outer  side,  bemg  careful  to  keep  the 
block  square  when  the  two  ends  of  the  plaster  are  stuck  to  the  limb. 


MEDICAL   HANDBOOK.  71 

A  roller  bandage  is  then  applied  over  the  plaster  from  the  ankle 
up.  A  strong  cord  is  then  passed  through  the  hole  in  the  block 
and  knotted  so  that  it  can  not  slip  through,  the  other  end  being 
passed  over  a  pulley  attached  to  the  foot  of  the  bed  or  elsewhere,  as 
may  be  convenient,  on  a  Ime  with  the  extended  limb,  and  a  weight 
of  from  5  to  30  pounds,  as  may  be  necessary  or  comfortable  to  the 
patient,  gradually  increased,  attached,  .  The  same  kind  of  apparatus 
may  be  used  with  the  double-inclined  plane,  except  that  the  plaster 
is  applied  only  to  the  thigh,  the  stirrup  coming  just  below  the  bent 
knee. 

Counter  extension  may  be  obtained  by  raising  the  foot  end  of  the 
bed  on  blocks  4  to  6  inches  high.  The  short  splints  should  be  well 
padded  and  extend  well  above  and  below  the  fracture,  and  be  held 
in  place  by  strips  of  plaster  or  bandage. 

The  long  splint  gives  additional  support  and  prevents  outward 
rotation  of  the  leg.  It  should  be  well  padded,  and  have  a  cross- 
piece  at  the  lower  end  to  keep  it  in  position.  Treatment  will  be 
required  for  a  period  of  8  to  10  weeks,  but  the  extension  may  be 
lessened  about  the  end  of  the  sixth  week  and  passive  motion  made  at 
the  knee  joint. 

FRACTURE  OF  THE  KNEECAP. 

Fracture  of  the  kneecap  may  be  transverse,  vertical,  or  obhque. 
The  bone  may  be  broken  into  two  or  more  irregularly  shaped  pieces- 
Symptoms  and  signs. — Loss  of  power,  inability  to  extend  the  joint 
or  raise  the  limb  from  the  bed.  In  the  transverse  variety  the  frag- 
ments are  widely  separated.  If  seen  soon  after  the  accident,  the 
line  of  fracture — the  gap  between  the  fragments — may  be  seen  and 
felt.     Swelling  rapidly  appears  and  the  signs  are  obscured. 

Treatment. — ^Various  forms  of  apparatus  are  employed,  and  in  hos- 
pital practice  the  injury  is  frequently  treated  by  surgical  operation, 
with  good  result.  The  simplest  form  of  treatment  is  to  place  the 
limb  on  a  long  posterior  sphnt  with  the  foot  raised  so  as  to  relax  the 
thigh  muscles,  or  if  the  patient  is  propped  up  in  bed  by  pdlows  or  a 
back  rest,  the  hmb  may  be  allowed  to  he  on  a  level. 

This  splint  should  be  apphed  as  follows:  A  padded  straight  board 
should  be  bound  on  the  back  of  the  limb,  extending  from  the  heel  to 
the  upper  part  of  the  thigh.  A  folded  towel  placed  at  the  back  of  the 
knee,  allowing  the  joint  to  bend  slightly,  will  be  conifortable.  One 
handkerchief  or  bandage  should  be  apphed  below  the  kneecap,  passing 
up  and  knotted  at  the  back  above  the  knee.  Another  handkerchief 
should  be  passed  above  the  kneecap,  and  be  knotted  at  the  back 
below  the  knee  (fig.  28) .  Nails  driven  into  the  edge  of  the  board  at 
convenient  points  assist  in  holding  the  bandage  in  position. 


72 


LIGHTHOUSE    SERVICE. 


Apply  iced  water  or  the  ice  bag  for  a  few  days.  If  swelling  or 
numbness  of  the  foot  is  complained  of  the  bandage  is  too  tight  and 
must  be  removed. 

If  the  bandages  become  loose,  as  they  are  apt  to  do  every  few  days, 
they  should  be  reapplied. 

The  long  sphnt  should  be  worn  about  six  weeks  or  two  months, 
when  it  may  be  replaced  by  a  shorter  molded  splint  of  leather,  felt, 


Fig.  28. 

or  pasteboard  to  prevent  motion  at  the  joint  when  the  patient  may 
be  allowed  to  walk  with  canes  or  crutches.  The  short  splint  should 
be  worn  for  at  least  a  month,  and  then  a  suitably  constructed  knee- 
cap should  be  worn  for  one  year  to  support  the  joint.  More  or  less 
stiffness  of  the  joint  is  to  be  expected. 

FRACTURE  OF  THE  LEG  (BETWEEN  THE  KNEE  AND  ANKLE). 

The  leg  extends  from  the  knee  to  the  ankle  and  has  two  bones, 
tibia  and  fibula. 

Fracture  of  the  leg  may  be  simple  or  compound.  Both  bones  may 
be  broken  or  only  one;  the  Hne  of  fracture  may  be  oblique  or  trans- 
verse. When  both  bones  are  broken  at  the  middle  or  lower  third 
the  deformity  is  usually  quite  marked.  The  break  is  apt  to  be  in  an 
oblique  direction  and  at  a  lower  level  in  the  tibia  (the  shin)  than  in 
the  fibula.     In  simple  fracture  of  the  upper  part  of  the  leg  the  de- 


FiG.  29.— Shows  the  appearance  of  the  right  foot  after  a  "  Pott's  fracture." 

formity  may  be  less  marked,  but  if  the  knee  is  involved  there  may  be 
great  swelling  because  of  acute  and  serious  inflammation  of  the 
joint. 

When  the  shaft  of  only  one  bone  (the  tibia  or  fibula)  is  broken 
there  is  not  much  displacement,  because  in  such  case  the  sound  bone 
acts  as  a  side  splint.  Fracture  at  the  lower  end  of  the  tibia  at  the 
projection  on  inner  side  of  ankle  is  sometimes  mistaken  for  sprained 


MEDICAL   HANDBOOK. 


73 


ankle,  and  if  the  small  fragment  of  bone  is  not  accurately  adjusted 
and  kept  in  proper  position  the  result  may  be  a  weak  and  stiff  joint. 

The  fibula  may  be  fractured  at  any  point,  but  the  important  frac- 
ture of  this  bone  is  known  as  "Pott's  fracture"  (fig.  29).  This 
fracture  occurs  about  3  inches  above  the  ankle,  on  outer  side  of  the 
leg,  and  is  accompanied  or  comphcated  by  outward  dislocation  of  the 
foot,  and  not  infrequently  by  the  breaking  or  tearing  off  of  the  tip 
of  the  lower  end  of  the  tibia. 

Treatment. — If  the  line  of  fracture  is  oblique  the  limb  must  be 
handled  very  carefully  so  as  to  prevent  injury  to  the  soft  parts  by  the 
sharp  ends  of  the  bone  and  thus  avoid  the  conversion  of  a  simple 
fracture  into  a  compound  one. 

The  treatment  of  fracture  of  the  leg  has  been  described  under  the 
heading  '' Simple  fractures,"  page  58. 

A  Pott's  fracture  should  be  treated  as  follows:  Take  a  board  splint 
long  enough  to  extend  from  the  knee  to  a  few  inches  beyond  the  sole 
of  the  foot.  Pad  the  splint  well,  having  the  lower  end  of  the  pad- 
ding at  least  2  inches  thick,  and  do  not  let  it  extend  quite  to  the  ankle 


B  A 

Fig.  30.— Shows  the  splmt  applied  for  a  "  Pott's  fracture."  A  shows  the  thick  padding  (3  laches)  ending 
just  above  the  ankle.  The  bandage  B  keeps  the  foot  tiirned  ia  and  prevents  the  tendency  to  outward 
displacement. 

joint  below.  Apply  the  splint  to  the  inner  side  of  the  leg  so  that  the 
foot  and  ankle  jDroject  below  the  padding.  The  foot  and  leg  are 
then  bandaged  to  the  splint  in  such  a  way  as  to  turn  the  foot  inward 
and  thus  correct  the  outward  displacement.     (Fig.  30.) 


FRACTURE  IN  FOOT. 

If  a  bone  in  the  foot  is  broken,  have  the  patient  place  his  sound 
foot  on  a  thin  board  or  heavy  pasteboard.  With  a  lead  pencil  draw 
an  outhne  of  the  foot,  allowing  an  eighth  of  an  inch  extra  all  the 
way  around.  Cut  this  out,  turn  it  over,  and  it  will  fit  the  sole  of 
the  injured  foot.  Pad  this  and  bind  it  to  the  foot,  the  starch  bandage 
making  an  excellent  dressing.  Leave  the  toes  exposed  for  observa- 
tion of  the  circulation. 

DISLOCATIONS. 

A  bone  is  dislocated  or  "out  of  joint"  when  it  is  displaced  or 
forcibly  separated  from  another  bone  entering  into  the  composition 
of  a  joint. 


74  LIGHTHOUSE    SERVICE. 

Dislocations  may  be  complete  or  incomplete.  A  dislocation  is 
complete  when  the  articular  surfaces  are  entirely  separated  and  the 
ligaments  torn,  as  in  dislocation  of  the  hip  joint;  incomplete  when 
the  articular  surfaces  are  not  entirely  displaced.  Dislocations  may 
be  simple,  compound,  or  complicated. 

A  dislocation  is  simple  when  there  is  no  wound  of  the  skin  and  soft 
parts — when  the  articular  surfaces  are  not  exposed  to  the  outer  air; 
compound  when  there  is  an  open  wound  and  the  outer  air  is  brought 
into  contact  with  the  articular  surfaces  of  the  joint;  complicated 
when  besides  the  dislocation  there  is  a  fracture  and  serious  damage 
to  the  soft  parts,  or  to  blood  vessels  or  nerves. 

Dislocations  are  said  to  be  most  common  in  adult  or  middle  life, 
when  the  bones  are  strong  and  the  muscles  powerful.  In  the  young 
and  old  the  bones  arc  more  apt  to  break.  There  are,  however,  strik- 
ing exceptions  to  this  rule  when  applied  to  the  elbow  joint  and  the 
shoulder  joint.  The  elbow  joint  in  young  subjects  is  frequently  dis- 
located; and  dislocation  of  the  shoulder  joint  in  old  men  is  not 
imcommon. 

Symptoms  and  signs  of  dislocations. — Deformity  is  always  present 
and  may  be  determined  by  comparing  the  injured  side  with  the 
sound  one.  The  head  or  end  of  the  bone  is  in  an  abnormal  position; 
the  attitude  of  the  limb  is  changed;  the  patient  can  not  move  the 
hmb;  and  when  effort  is  made  to  move  the  joint  it  is  found  to  be  very 
stiff.  There  may  be  shortening  or  lengthening.  For  example,  in 
dislocation  of  the  hip  the  head  of  the  thigh  bone  may  be  thrown 
outward  and  upward,  when  there  will  be  shortening  of  the  leg;  or  it 
may  be  forced  downward  and  inward,  when  the  length  of  the  limb 
will  be  increased. 

Treatment. — The  indications  are  to  replace  the  bones  in  their 
natural  position  and  to  keep  the  parts  at  rest  until  the  ligaments  and 
damaged  tissues  about  the  joint  are  healed.  A  dislocation  should  be 
reduced  immediately  after  the  accident  while  the  patient  is  faint 
and  the  muscles  are  in  a  relaxed  condition. 

Having  thus  briefly  described  a  dislocation  and  the  treatment  indi- 
cated, the  question  now  arises.  How  shall  the  treatment  be  applied, 
how  shall  the  dislocation  bo  reduced  ?  And  when  it  is  taken  into  con- 
sideration that  the  reduction  of  dislocations  not  infrequently  taxes 
the  skill  of  the  most  experienced  surgeon  (even  with  the  aid  of  gen- 
eral anesthetics),  it  is  hardly  to  be  expected  that  a  nonprofessional 
man  will  be  able  to  accomplish  the  desired  results  in  many  cases.  It 
must  also  be  borne  in  mmd  that  there  are  certain  dangers  attending 
efforts  at  reduction,  especially  at  the  larger  joints,  if  improperly  or 
too  forcibly  apphed — such  as  fracture  of  bone  or  rupture  of  blood 
vessel. 


MEDICAL   HANDBOOK.  75 

DISLOCATION  OF  THE  FINGERS. 

Dislocation  of  the  bones  of  the  fingers  may  be  backward  or  forward. 

Treatment. — Extension  and  counter  extension  and  manipulation. 
Pull  the  finger  directly  in  line  with  the  hand,  and  when  fidly  ex- 
tended make  pressure  on  the  head  of  the  bone.  Reduction  is  usually 
effected  without  much  difficulty.  Place  the  finger  on  a  well-padded 
splint  for  one  week,  then  make  passive  motion,  and,  if  necessary,  the 
splint  may  be  worn  for  another  week. 

DISLOCATION  OF  THE  THUMB. 

Dislocation  of  the  thumb  may  be  backward  or  forward. 

Treatment. — The  treatment  is  not  the  same  as  for  dislocation  of 
the  fingers,  and  reduction,  especially  of  the  backward  dislocation,  is 
usually  very  difficult.  Try  by  pushing  the  end  of  the  thumb  upward 
and  backward  until  it  stands  perpendicularly  on  the  bone  from  which 
it  is  dislocated,  then  make  strong  pressure  against  the  base  of  the 
dislocated  bone  from  behind  forward,  sliding  it  on  the  bone  beneath 
till  it  gets  to  the  end,  then  flex  or  bend  the  thumb  mto  place. 

DISLOCATION  OF  THE  WRIST. 

Dislocation  of  the  wrist  joint  may  be  backward  or  forward.  It  is 
a  rare  injury.  Fracture  about  the  wrist  is  more  common,  and  is 
sometimes  mistaken  for  dislocation.  A  stiff  joint  is  apt  to  be  the 
result. 

Treatment. — Extension,  counter  extension,  and  direct  pressure. 
Grasp  the  hand  of  the  patient,  pull  in  a  straight  line,  and  have  an 
assistant  pull  on  the  forearm  in  the  opposite  direction,  and  when  the 
parts  are  fully  extended  make  direct  pressure  upon  the  wrist  bones. 
Apply  a  bandage,  and  place  the  hand  and  forearm  on  a  well-padded 
splint  for  a  week;  then  remove  the  splint  and  make  passive  motion  at 
the  joint;  reapply  the  splint  and  remove  it  after  an  interval  of  an- 
other week.  If  there  is  much  pain  or  swelling  after  reduction  of  the 
dislocation,  apply  cold  water. 

DISLOCATION  OF  THE  ELBOW. 

Dislocations  of  the  elbow  are  seri^)us  accidents.  They  present  a 
variety  of  forms,  backward,  forward,  outward,  and  inward,  and  these 
are  divided  into  a  number  of  subvarieties.  One  or  both  bones  may  be 
involved,  and  the  dislocation  may  be  associated  with  fracture.  Re- 
duction in  some  cases  is  comparatively  easy;  in  others  it  is  very  diffi- 
cult, even  in  the  hands  of  experienced  surgeons. 

Without  a  thorough  Imowledge  of  the  anatomy  of  the  normal  joint 
it  is  very  difficult  to  understand  the  different  forms  of  dislocation,  and 
of  necessity  equally  difficidt  to  apply  the  proper  treatment. 


76 


LIGHTHOUSE   SERVICE. 


Immediately  after  the  accident  and  before  swelling  sets  in  the 
injured  elbow  should  be  carefully  compared  v/ith  the  sound  one. 
When  the  normal  arm  is  extended  (straight)  the  tip  of  the  elbow  and 
the  bony  points  on  either  side  should  be  in  a  transverse  line  across  the 
joint.  If  these  prominences  are  found  out  of  line,  dislocation  or  frac- 
ture is  probably  present. 

Treatment. — Fixation  of  the  arm  above  the  elbow,  extension  or 
flexion  of  the  forearm,  and  direct  pressiu-e  by  means  of  the  thumbs  or 

fingers  on  the  head  of  the 
dislocated  bone,  so  as  to 
push  it  back  mto  the  socket. 
After  reduction  an  angular 
splint  should  be  applied  to  in- 
ner side  of  arm,  lightly  band- 
aged, and  the  forearm  carried 
in  a  sling.  Cold  water  may 
be  applied  to  reduce  inflam- 
matory action.  Passive  mo- 
tion should  be  employed  at 
the  end  of  a  week. 

DISLOCATION    OF    THE 
SHOULDER. 


[After  Helfrich.] 

Dislocation  of  the  shoul- 
der joint  is  a  very  common 
accident.  It  occurs  as  fre- 
quently as  aU  other  disloca- 
tions put  together.  The  fre- 
quency is  explained  by  the 
great  latitude  of  motion  of 
the  joint,  the  shallowness  of 
the  socket,  and  the  size  and 
rounded  shape  of  the  head  of  the  bone,  the  laxity  of  the  capsular 
ligament,  and  the  leverage  exerted  on  the  joint  by  the  long  bone. 

There  are  three  chief  forms  of,  dislocation  of  the  shoulder — (1)  for- 
ward and  downward  below  the  coUar  bone,  (2)  directly  downward 
into  the  armpit,  and  (3)  backward  on  the  shoulder  blade. 

The  symptoms  and  signs  are  pain,  swelling,  rigidity  (stiffness), 
loss  of  power,  flattening  and  angular  appearance  of  the  shoulder  as 
compared  with  the  other  shoulder,  abnormal  situation  of  the  head  of 
the  bones,  and  change  m  the  axis  of  the  long  bone.  (Fig.  31.)  In 
the  first  variety,  the  most  common  of  all,  the  head  of  the  bone  may 
be  felt  in  front  of  the  armpit  and  below  the  coUar  bone,  and  the  elbow 
points  outward  and  backward.  In  the  second  the  head  of  the  bone 
may  be  felt  in  the  armpit,  and  the  elbow  points  outward.     In  the 


Fig.  31.— Dislocation  of  the  right  shoulder. 


MEDICAL  HANDBOOK.    .  77 

third  the  head  of  the  bone  may  be  felt  on  the  back  of  the  shoiddcr 
blade,  the  elbow  points  forward,  and  the  forearm  is  thrown  across 
the  chest.  Another  valuable  sign  is  that  when  the  elbow  is  placed  on 
the  chest  the  patient  can  not  place  the  hand  of  the  injured  side  upon 
the  opposite  shoulder,  or  if  the  hand  is  placed  on  the  shoulder  the 
elbow  can  not  be  brought  into  contact  with  the  chest. 

Treatment. — The  treatment  for  the  first  variety  (forward  and 
downward)  is  as  follows:  Lay  the  patient  down  or  let  him  sit  on  a 
chair;  bend  the  forearm  on  the  arm;  press  the  elbow  against  the 
side  of  the  chest  and  hold  it  there;  rotate  the  arm  outward  by  carry- 
ing the  forearm  outward;  pull  steadily  on  the  arm  and  rotate  inward 
by  carrying  the  elbow  upward  and  forward  with  forearm  across  the 
chest.  While  this  is  going  on  have  an  assistant  place  his  hand  m  the 
armpit  and  press  the  head  of  the  bone  into  place. 

For  the  second  variety  (directly  downward  into  the  armpit)  place 
the  patient  on  his  back;  remove  your  boot;  place  your  heel  in  the 
armpit;  grasp  the  wrist  and  pull  steadily  on  the  arm.  If  the  dislo- 
cation is  in  the  right  shoulder,  seat  yourself  on  the  right  side  of  the 
patient  and  use  your  right  foot;  and  if  the  injury  is  in  the  left 
shoulder  seat  yourself  on  the  left  side  and  use  your  left  foot.  The 
same  principles  may  be  carried  out  by  seating  the  patient  on  a  low 
chair  and  placing  your  knee  in  the  armpit. 

Another  method  is  to  have  an  assistant  stand  upon  a  table  and 
make  counterextension  with  a  towel,  or  a  strong  piece  of  soft  cloth 
of  any  kind,  passed  under  the  armpit  of  the  patient,  while  the  oper- 
ator pulls  the  arm  downward.  The  same  method  may  be  employed 
by  causing  the  patient  to  He  on  his  back,  and  an  additional  advantage 
may  be  obtained  by  placing  a  rolled  bandage  or  a  pad  of  any  kind  in 
the  folds  of  a  towel  in  the  armpit. 

In  dislocation  backward  on  the  shoulder  blade,  puU  the  arm  for- 
ward and  make  direct  pressure  forward  on  the  head  of  the  bone,  or 
stand  behind  the  patient,  draw  the  elbow  backv/ard,  and  with  the 
thumb  press  upon  the  head  of  the  bone  and  guide  it  into  place. 

After  reduction  a  soft  pad  should  be  placed  in  the  armpit,  the 
upper  arm  bandaged  to  the  body,  and  the  forearm  placed  in  a  sling 
across  the  chest.  Passive  motion  at  the  joint  should  begin  at  the 
end  of  a  week  and  be  repeated  daily,  but  the  arm  should  be  carried 
in  the  shng  about  three  weeks. 

DISLOCATION  OF  THE  COLLAR  BONE. 

The  collar  bone  extends  from  the  upper  border  of  the  breast  bone 
to  the  highest  point  of  the  shoulder  blade.  Dislocation  may  occur 
at  either  end.  Reduction  is  comparatively  easy,  but  it  is  difficult 
to  retain  the  bone  in  position. 

Treatment. — ^Make  extension  by  drawing  back  the  shoulders,  the 
knee,  if  necessary,  being  placed  between  the  shoulder  blades;  push 


78  .  .  LIGHTHOUSE    SERVICE. 

the  end  of  the  bone  in  place  and  try  to  keep  it  there  by  a  firm  pad 
fastened  by  adhesive  jDlaster  and  bandage.  The  best  result  may  be 
obtained  by  placing  the  patient  at  rest  on  his  back  for  thi'ee  weeks. 

DISLOCATION  OF  THE  TOES. 

Dislocations  of  the  toes  are  very  rare  accidents.  The  treatment  is 
the  same  as  for  dislocation  of  the  fingers.  Dislocation  of  the  big  toe 
may  be  treated  the  same  as  dislocation  of  the  thumb. 

DISLOCATION  OF  THE  ANKLE. 

The  foot  may  be  dislocated  forward,  backward,  outward,  inward, 
or  upward.     The  dislocation  may  be  complete  or  incomplete. 

The  lower  ends  of  the  bones  of  the  leg  enter  into  the  formation  of 
the  ankle  joint,  the  end  of  the  tibia  on  the  inner  side  and  the  end  of 
the  fibula  on  the  outer  side  of  the  joint.  Dislocations  of  the  ankle 
are  usually  comphcated  by  fracture  of  the  tip  of  one  or  both  of  these 
bones.  When,  in  addition,  the  fibula  is  broken  above  the  ankle,  the 
injury  is  known  as  Pott's  fracture,  already  referred  to. 

Treatment. — Extension,  counterextension,  and  pressure.  Flex 
the  leg  on  the  thigh  and  the  thigh  at  right  angle  to  body;  pull 
steadily  on  the  foot,  while  an  assistant  makes  counterextension  at 
the  thigh,  and  press  the  bones  in  place.  Apply  cold  water  and  place 
the  foot  and  leg  in  a  fractm'e  box  or  apply  well-padded  molded 
splints.  Binder's  board  dipped  in  warm  water  and  molded  to  the 
part  and  Uned  with  thick  layers  of  cotton  wiU  answer  the  purpose. 
If  a  Pott's  fracture,  use  the  splint  shown  in  figure  30.  Make  passive 
motion  at  the  joint  at  the  end  of  two  weeks. 

DISLOCATION  OF  THE  KNEE. 

Dislocation  of  the  knee  may  be  complete,  incomplete,  compomid, 
or  complicated.  The  direction  of  the  dislocation  may  be  forward, 
backward,  outward,  or  inward.  The  deformity  is  quite  marked. 
Reduction  is  not  very  difficult,  but  the  injury  is  a  serious  one  and 
care  must  be  taken  ui  making  reduction  not  to  produce  additional 
damage  by  too  forcible  extension.  Fortunately  the  injury  is  exceed- 
ingly rare. 

Treatment. — Extension,  counterextension,  and  pressure.  Have  one 
assistant  puU  steadily,  not  too  hard,  on  the  leg  or  ankle,  while  another 
fixes  or  pulls  on  the  thigh  and  presses  the  bone  into  place.  After 
reduction  apply  cold  water,  and  place  the  leg  in  a  posterior  straight 
sphnt,  well  padded,  especially  below  the  hollow  of  the  knee,  and 
make  passive  motion  at  the  end  of  two  weeks.  When  the  patient 
begins  to  walk,  a  kneecap  or  flannel  bandage  should  be  applied. 


MEDICAL   HANDBOOK. 


79 


DISLOCATION  OF  THE  HIP. 

Dislocation  of  the  hip  joint  is  a  serious  injury.  It  occurs  much  less 
frequently  than  dislocation  of  the  shoulder  joint.  The  socket  of  the 
hip  joint  is  very  deep,  and  the  ligaments  and  muscles  surrounding  the 
joint  are  very  strong  and  powerful.  Dislocation  occurs  only  when 
the  limb  is  in  a  certain  position,  when  its  axis  is  changed  from  that 
of  the  body,  and  when  in  consequence  of  any  sudden  or  great  force 
received  on  the  lower  end  of  the  leg  or  knee  the  head  of  the  bone  is 
forced  through  the  ligament  (the  capsule)  which  surrounds  the  joints. 
The  head  of  the  bone  may  then  be  thrown  (1)  backward  and  upward, 


Fig.  32. 


Fig.  33. 


Fig.  32  shows  a  backward  dislocation  of  the  hip  with  the  knee  and  toe  turned  in  and  the  heel  raised  and  the 
limb  shortened.  Fig.  33  shows  a  forward  and  downward  dislocation  of  the  right  hip  with  the  knee  and 
toe  turned  out  and  the  limb  lengthened. 

(2)  backward,  (3)  forward  and  downward,  (4)  forward.  The  dif- 
ferent dhections  indicate  the  different  forms  of  dislocation.  The 
first  is  the  most  common. 

In  the  first  form,  examination  from  below  up  shows  the  big  toe 
turned  toward  or  restmg  on  the  instep  of  the  opposite  foot;  the  knee 
flexed  and  resting  against  thigh  at  upper  margin  of  opposite  knee- 
cap; the  thigh  rotated  inward  and  drawn  toward  its  fellow;  bulging 
of  the  hip;  and  about  2  inches  shortening  of  the  entire  limb. 

In  the  second  form  the  signs  are  the  same  as  in  the  first,  but  less 
marked  (fig.  32).  Fracture  of  the  neck  of  the  thigh  bone  is  some- 
times mistaken  for  this  injury.  But  in  fracture  there  is  abnormal 
motion,  and  the  foot  is  turned  outward. 

In  the  third  form  (fig.  33)  the  signs  are  almost  exactly  the  reverse 
of  the  first  form.  The  foot  and  knee  are  turned  outward,  the  hip  is 
flattened,  and  the  entire  limb  is  lengthened. 


80  LIGHTHOUSE   SERVICE. 

The  signs  of  the  fourth  form  are  nearly  the  same  as  those  of  the 
third,  except  that  the  entire  limb  is  shortened. 

Treatment. — ^The  treatment  is  by  manipulation,  or  by  extension 
and  counterextension. 

For  the  first  and  second  forms  of  dislocation,  above-described  treat- 
ment may  be  applied  as  follows:  Place  the  patient  on  his  back  on  a 
mattress  on  the  floor.  Seize  the  foot  or  ankle  with  one  hand  and 
place  the  other  hand  under  the  knee.  Flex  the  leg  upon  the  back  of 
the  thigh,  and  the  thigh  upon  the  body  to  about  a  right  angle ;  then 
carry  the  knee  inward  and  rotate  it  inward  on  its  own  axis,  then  sud- 
denly raise  it  (lift  it  toward  the  ceiling)  so  that  the  head  of  the  bone 
may  be  thrown  over  the  rim  of  the  socket,  and  immediately  extend 
the  limb  with  outward  rotation  to  its  normal  position  so  that  the  head 
of  the  bone  may  return  to  the  socket  through  the  hole  in  the  capsule 
by  which  it  escaped. 

The  treatment  of  the  tliird  and  fourth  forms  of  injury  corresponds 
to  that  for  the  first  and  second,  except  that  the  limb  should  be  carried 
outward  first,  then  inward,  across  the  median  line,  and  rotated 
inward  on  its  own  axis,  and  then  suddenly  lifted  and  brought  down 
to  its  normal  position  by  the  side  of  its  fellow. 

No  great  force  should  be  used  in  making  these  movements.  If  any 
considerable  resistance  is  met  with  in  rotating  or  lifting  the  bone  the 
movement  should  be  modified  in  such  a  way  that  the  head  of  the  bone 
may  follow  the  path  of  least  resistance. 

If  extension  and  counterextension  be  applied  they  should  foUow 

the  line  of  the  axis  of  the  dislocated  thigh.     It  must  not  be  forgotten 

in  the  consideration  of  these  methods  that  the  application  of  too 

much  force  or  of  force  improperly  applied  may  produce  fracture  of 

the  bone. 

SPRAINS, 

A  sprain  is  a  stretching  or  wrenchmg  of  a  joint.  The  joints  most 
frequently  affected  are  the  ankle,  wrist,  knee,  and  shoulder. 

The  symptoms  and  signs  are  pain,  swelling,  impairment  or  loss  of 
motion,  and  discoloration  from  effusion  of  blood.  When  there  is 
much  swelling  it  may  be  difficult  to  determine  whether  sprain  or 
fracture,  or  both,  are  present. 

As  explained  under  '' Broken  bones,"  page  57,  it  is  sometimes  very 
difficult  to  determine  whether  an  injury  near  a  joint  is  a  sprain,  a 
bruise,  a  broken  bone,  or  aU  combined;  and  if  there  is  doubt,  the 
case  should  be  treated  as  a  broken  bone.  Injuries  about  the  ankle 
joint  are  especially  confusing,  and  sometimes  the  X  ray  shows  a 
fracture  that  could  not  have  been  detected  in  any  other  way.  It 
should  also  be  understood  that  a  sprain,  particularly  if  some  of  the 
soft  parts  about  the  joint  are  torn,  may  be  much  longer  in  being 
restored  to  a  normal  condition  than  if  a  simple  break  of  the  bone  had 
occurred  without  other  injury. 


MEDICAL   HANDBOOK.  81 

Treatment. — Either  hot  or  cold  apphcations  are  good  first-aid 
measures,  but  they  should  be  distinctly  either  hot  or  cold,  and  not 
tepid.  Soaking  the  part  for  haK  an  hour  several  times  a  day  in 
water  as  hot  as  can  be  borne,  and  gently  rubbing  the  skin,  are  ex- 
cellent. If  it  is  more  convenient  to  apply  a  bag  of  ice,  this  can  be 
used,  but  the  heat  and  cold  should  not  alternate.  Propping  the 
part  up  on  piEows  assists.  If  there  is  much  pain,  great  relief  is 
obtained  by  surrounding  the  joint  with  a  thick  layer  of  cotton  and 
applying  a  plaster  bandage.  The  circulation  of  the  lower  part  of  the 
limb  should  be  watched,  and  if  found  to  be  impaired,  the  bandage 
should  be  cut  from  above  downward,  and  the  sides  spread  apart  to 
relieve  any  constriction  that  may  be  present.  After  the  swelling  has 
subsided  somewhat,  rubbing  with  any  kind  of  liniment  or  with  alcohol 
wiU  help,  but  it  is  the  rubbing  more  than  the  liniment  that  does 
the  good. 

It  is  a  popular  behef  among  laymen  that  a  large  quantity  of  hni- 
ment,  perhaps  applied  on  flannel  cloth,  is  aU  that  is  necessary,  and 
that  the  rubbing  is  only  of  secondary  importance.  This  is  a  decided 
mistake.  Later  on  the  part  should  be  grasped  and  gently  moved  in 
various  directions,  making  what  is  known  as  passive  motion.  In 
some  cases  this  is  inadvisable  and  the  patient  appears  to  do  better 
under  perfect  rest,  which  can  be  obtained  by  strapping  the  joint  with 
strips  of  sticking  plaster,  or  placing  the  limb  in  a  splint.  The  black 
and  blue  condition  of  the  skin  that  sometimes  appears  wiU  gradually 
subside  as  the  part  gets  better. 

WOUNDS. 

Doctors  divide  wounds  into  several  classes,  namely,  incised,  lacer- 
ated, contused,  punctured,  poisoned,  and  gunshot.  The  nature  of 
the  fii'st  three  is  sufficiently  clear  from  their  names  and  from  a  first- 
aid  standpoint  may  be  considered  together.  The  first  thing  to  do  is 
to  control  severe  bleeding  by  pressure  on  the  wound  or  upon  a  dis- 
tant part  of  the  blood  vessel,  as  explained  in  the  chapter  on  ''Bleed- 
ing," Then,  after  the  dresser  has  disinfected  his  own  hands,  the 
wound  should  be  thoroughly  cleansed  and  disinfected;  these  matters 
will  be  explained  in  the  chapter  on  "Antiseptics."  Iodine,  if  at 
hand,  is  the  best  agent  to  use.  If  the  wound  is  on  a  hauy  part,  as 
the  scalp,  the  hair  should  be  shaved  for  a  distance  of  several  inches 
from  the  wound.  An  antiseptic  dressing  should  then  be  apphed,  or 
in  the  absence  of  any  such  agent  one  may  use  a  clean  cloth  boded  for 
10  minutes  in  clear  water  or  in  water  to  which  table  salt  has  been 
added  in  the  proportion  of  1  teaspoonful  to  the  pint.  This  dressing 
is  retained  by  a  bandage,  and  should  not  be  disturbed  for  any  reason 
except  bleeding  if  the  doctor  can  be  reached  within  48  hours. 

9S90S°— 15 6 


82  LIGHTHOUSE   SERVICE. 

If  it  is  impossible  to  secure  the  services  of  a  doctor  for  several 
days,  and  the  wound  gapes  to  such  an  extent  that  it  can  not  be 
readHy  closed  by  bandaging,  or  is  in  a  part  where  a  scar  will  mean 
disfigurement,  the  layman  may  attempt  to  close  the  wound  by  stitch- 
ing, and  this  can  be  done  by  using  an  ordinary  sewing  needle  with 
silk  or  linen  tliread,  both  boiled  for  10  minutes,  the  needle  being 
pushed  through  the  flesh  by  means  of  a  thimble,  also  boiled.  The 
stitches  should  pierce  the  skin  about  an  eighth  or  quarter  of  an  inch 
from  the  edge  of  the  wound,  and  come  out  of  the  fleshy  part  of  the 
wound  about  the  same  distance  from  the  skin.  They  should  be  placed 
about  haK  an  inch  apart,  and  each  one  should  be  tied  and  cut  off. 
The  stitches  should  only  be  drawn  tight  enough  to  barely  close  the 
wound,  because  the  swelhng  may  make  them  too  tight.  No  wound 
should  be  closed  by  a  layman  without  leaving  dramage;  that  is, 
something  that  will  lead  off  the  bloody  water  that  oozes  from  a 
wound. 

A  piece  of  boiled  sewing  silk  or  linen  folded  back  and  forth  and 
then  twisted  until  it  makes  a  skein  one-eighth  of  an  inch  thick 
should  be  laid  in  the  bottom  of  the  wound  and  allowed  to  hang  out 
at  the  lower  end  for  a  distance  of  an  inch.  This  drains  by  capillary 
attraction,  and  there  is  far  less  danger  of  blood  poison  than  if  the 
wound  were  closed  tightly.  This  drain  should  be  removed  after  24 
hours  by  simply  drawing  it  out  without  disturbing  the  stitches.  The 
stitches  themselves  should  be  left  m  place  from  three  to  six  days, 
depending  principally  upon  the  depth  of  the  wound  and  its  tendency 
to  gape.  The  stitching  of  a  wound  should  only  be  attempted  by  a 
layman  when  a  doctor  can  not  be  reached  within  48  hoiu-s. 

The  closure  of  a  wound  by  sticking  plaster  is  a  questionable  expe- 
dient, because  it  seals  the  wound,  prevents  drainage,  and  blood  poi- 
son may  follow.  If  the  wound  is  not  large,  a  strip  of  boiled  cloth 
may  be  laid  directly  over  it  and  the  wound  then  drawn  together  by 
strips  of  sticking  plaster  applied  outside  the  cloth. 

Whether  the  wound  is  closed  by  stitches  or  not,  the  layman  should 
apply  an  antiseptic  dressing,  if  such  is  available,  and  if  not,  a  boiled 
cloth,  as  described  above,  can  be  used. 

A  badly  contused  or  bruised  wound  should  not  be  stitched  by  a 
layman.  In  a  lacerated  wound  it  may  be  necessary  to  trim  off  with 
boiled  scissors  a  few  ragged  edges  of  skin  before  stitching. 

If  a  wound  has  penetrated  the  beUy  and  the  bowel  is  protruding, 
it  is  best  not  to  attempt  to  push  it  back  if  the  doctor  can  be  reached 
within  a  few  hours.  It  should  be  gently  washed  with  the  salt  solu- 
tion, described  elsewhere  (p.  81),  and  kept  covered  with  towels  fre- 
quently wet  with  the  same  solution.  If  a  doctor  can  not  be  reached 
within  a  few  hours,  and  the  person  in  charge  of  the  patient  after  a 
careful  examination  is  sure  that  the  bowel  has  not  been  opened  or 


MEDICAL    HANDBOOK.  83 

otherwise  seriously  injured,  he  should,  after  carefully  washing  the 
bowel  with  the  salt  solution  mentioned  above,  return  it  to  the  belly. 
If  the  bowel  is  allowed  to  remain  for  too  great  a  time  outside  of  the 
beUy,  its  circulation  may  be  cut  off  by  the  pressure  of  the  belly  walls 
and  gangrene  result.  If  the  bowel  has  been  opened  or  severely 
bruised,  it  should  not  be  returned,  as  there  is  danger  of  forcing  fecal 
matter  out  of  the  bowel  into  the  belly  cavity,  which  would  cause  a 
dangerous  inflammation.  If  the  bowel  is  not  protruding  from  the 
wound,  simply  treat  as  an  ordinary  wound. 

Punctured  wounds. — ^A  punctured  wound  is  one  made  by  a  pierc- 
ing agent,  such  as  a  nail,  tack,  knife,  or  needle.  Such  a  wound  is 
dangerous,  because  it  almost  completely  closes  and  does  not  drain. 
If  germs  are  introduced  at  the  time  of  the  accident,  they  can  not  escape. 
A  wound  of  this  kind,  except  of  the  chest  or  beUy,  should  be  disin- 
fected or  burned,  and  the  best  agent  is  pure  carbolic  acid.  In  the 
absence  of  suitable  instruments  a  knitting  needle  or  other  thin  blunt 
implement  should  be  dipped  into  the  carbolic  acid  and  then  inserted 
to  the  full  depth  of  the  wound.  This  should  be  repeated  several 
times.  The  first  application  causes  a  burning  sensation,  but  the  acid 
itself  soon  deadens  the  part,  and  the  subsequent  applications  are  less 
painful.  If  the  knitting  needle  is  then  dipped  in  alcohol  or  whisky 
and  inserted  once  or  twice  and  a  little  is  applied  to  the  skin  about 
the  wound,  it  will  stop  the  burning  action  of  the  carbolic  acid.  In 
the  absence  of  carbolic  acid  the  alcohol  or  whisky  can  be  used  alone, 
but  are  far  less  efficient.  After  this  treatment  an  antiseptic  dress- 
ing or  a  boiled  cloth  should  be  applied  to  the  wound.  The  fre- 
quency with  which  lockjaw  follows  punctured  wounds,  particularly 
naU  wounds,  makes  it  imperative  that  the  doctor  be  consulted 
promptly  and  that  the  wound  be  not  regarded  as  trivial  because  it 
is  small  in  size. 

Poisoned  wounds. — The  principal  poisoned  wounds  met  with  are 
those  due  to  bites  of  animals  or  bites  and  stings  of  insects,  and  these 
wiU  be  considered  under  a  separate  heading.     (See  p.  93.) 

Gunshot  wounds. — ^A  gunshot  wound  is  similar  to  a  punctured 
wound  in  that  it  is  small  and  almost  completely  closes.  If  the  ball 
has  passed  entirely  through  a  part — as  the  leg — and  has  not  struck 
an  important  vessel  or  broken  a  bone,  the  wound  is  apt  to  cause  less 
trouble  than  one  in  which  the  ball  remains  in  the  flesh.  If  a  por- 
tion of  clothing  is  found  in  the  mouth  of  the  wound,  it  should  be 
removed.  The  part  should  be  well  cleansed  with  soap  and  hot  water 
and  an  antiseptic  dressing  or  a  boiled  cloth  applied.  Further  than 
this  it  is  not  best  for  the  layman  to  attempt  anything,  particularly 
probing  for  the  bullet.  If  a  bone  has  been  broken  by  the  ball,  the 
case  should  be  treated  as  described  under  "Compound  fracture." 


84  LIGHTHOUSE    SERVICE. 

BRUISES  AND  CONTUSIONS. 

A  bruise  or  contusion  is  an  injury  where  the  tissues  beneath  the 
skin  have  been  torn  but  the  skin  itself  has  not  been  opened.  Blood 
oozes  out  of  the  injured  vessels,  but  can  not  escape,  as  the  skin  is 
still  intact.  The  symptoms  are  swelling,  tenderness,  and  a  feeling  of 
soreness  or  pain.  Discoloration  of  the  skin  occurs  quickly  in  super- 
ficial contusions  and  in  places  where  loose  tissue  abounds,  but  only 
after  days  when  the  injury  is  deep-seated.  This  discoloration  is  at 
first  red  and  then,  successively,  purple,  black,  green,  and  yellow. 
This  play  of  colors  is  due  to  the  changes  which  take  place  in  the 
blood  while  undergoing  absorption. 

Treatment. — A  pad  of  gauze  or  soft  towel  should  be  tightly  band- 
aged over  the  injured  part  to  stop  hemorrhage,  after  which  cold 
should  be  applied  except  in  old  or  feeble  persons  or  where  the  con- 
tusion is  extensive.  In  the  latter  cases  heat  is  best,  as  cold  might 
cause  gangrene.  Evaporating  solutions — such  as  witch-hazel,  a  15 
per  cent  solution  of  alcohol  in  water,  or  a  saturated  solution  of 
Epsom  salts — arc  often  found  of  great  benefit.  A  contusion  should 
never  be  opened  except  in  rare  cases  when  it  is  necessary  to  stop  per- 
sistent bleeding.  If  an  opening  is  made  through  the  skin,  germs  are 
liable  to  enter  and  cause  severe  inflammation,  resulting  in  the  for- 
mation of  pus. 

FOREIGN  BODIES  IN  THE  EYE,  EAR,  NOSE,  AND  THROAT. 

Foreign  bodies  in  the  eye. — When  a  piece  of  steel,  a  cinder,  or  any 
foreign  body  enters  the  eye  nature  at  once  floods  the  eye  with  tears 
in  an  endeavor  to  wash  the  offending  agent  away,  and  frequently 
succeeds.  Sometimes,  however,  the  foreign  body  is  embedded  in 
the  eyebaU,  the  lid,  or  other  part  of  the  eye,  or  keeps  moving  about 
from  one  part  to  another  without  escaping;  then  assistance  is  neces- 
sary. 

Occasionally  drawmg  the  upper  lid  well  down  with  the  fingers, 
and  allowing  the  lashes  of  the  lower  lid  to  act  as  a  brush,  will  remove 
the  body  if  it  is  not  tightly  embedded.  UsuaUy,  however,  it  is  neces- 
sary to  invert  the  upper  lid ;  in  other  words,  turn  it  inside  out.  This 
is  not  difficult  with  a  little  practice.  The  upper  eyelid  contains  a 
piece  of  cartilage  or  gristle  along  its  lower  edge  wliich  makes  it  easier 
to  turn.  To  invert  the  eyelid  face  the  patient,  or  stand  behind  him 
as  seems  more  convenient;  have  him  look  well  down  toward  the  floor; 
take  hold  of  the  lashes  of  the  upper  lid  with  the  fingers  and  thumb 
of  one  hand;  then  lay  entirely  across  the  middle  of  the  eyelid  a  wooden 
toothpick,  match,  knitting  needle,  lead  pencil,  or  other  thin  object 
(fig.  34) ;  press  it  downward,  and  at  the  same  time  gently  puU  the 
lashes  upward,  when  the  lid  wiU  suddenly  turn  inside  out  (fig.  35). 


MEDICAL   HANDBOOK. 


85 


Fig.  34. 


Drawing  down  the  lower  lid  by  simply  pressing  upon  it  will  also 
expose  its  inside  surface.  If  the  foreign  body  is  seen,  it  should  be 
very  gently  removed  with  the  corner  of  a  handkerchief.  If  it  is 
partly  embedded  in  the  eyelid,  it  may  be  possible  to  gently  dislodge 
it  with  a  wooden  toothpick  or  other 
similar  object.  If  the  foreign  body 
is  on  the  eyeball,  it  sometimes  re- 
quires a  good  light,  good  eyesight, 
and  even  a  magnifymg  glass  to  de- 
tect it.  If  found,  it  should  be  re- 
moved with  a  handkerchief  or  other 
soft  material,  but  if  embedded  too 
tightly  to  be  removed  in  this  manner, 
it  is  best  for  the  layman  not  to  at- 
tempt anythmg  further  for  fear  of 
greater  injury  to  the  eye.  Under 
such  circumstances  one  or  both  of  the  eyes  should  be  snugly  band- 
aged with  a  soft  light-proof  material,  such  as  red  flannel,  and  the 
doctor  should  be   called    as   soon  as  possible.     The  patient  should 

be  cautioned  not  to  wink  his 
ej^es,  as  all  motion  will  increase 
the  irritation. 

If  you  have  succeeded  in  re- 
movmg  the  body,  and  the  eye 
appears  very  red,  a  little  sweet 
oil  dropped  in  will  be  very 
soothing.  It  should  be  remem- 
bered that  the  scratching  of  the 
eyeball  makes  it  feel  as  if  the 
body  were  still  present  after  its 
removal.  The  old  household 
remedy  of  dropping  a  flaxseed 
into  the  eye  in  the  hope  that 
in  slipping  about  it  may  dis- 
lodge the  body  is  said  by  spe- 
cialists to  do  no  good,  and  may 
do  harm. 

Foreign  bodies  in  the  ear. — 
Children  occasionally  place  but- 
tons or  similar  objects  in  the  ear.  If  near  the  outlet,  they  can  some- 
times be  removed  (m  the  absence  of  suitable  mstruments)  by  gently 
passing  along  one  side  a  crochet  needle  or  other  similar  implement.  It 
should  be  remembered,  however,  that  the  drum  of  the  ear,  which  is  ex- 
tremely delicate,  and  means  so  much  to  the  child  in  the  future,  is  only  a 
short  distance  inside,  and  any  effort  of  this  kind  made  by  the  la3Tnan 


Fig.  35. 


86  LIGHTHOUSE   SERVICE. 

should  be  very  gentle  indeed.  A  stream  of  water  from  a  small  syringe 
may  wash  the  object  out.  If  these  measures  do  not  succeed,  wait 
for  the  doctor  by  all  means.  Sometimes  an  insect  crawls  into  the 
ear.  The  actual  physical  danger  is  less  than  the  mental  horror,  as 
the  insect  soon  dies.  A  little  sweet  oil  dropped  into  the  ear  may 
cause  the  insect  to  back  out  to  free  itself  from  the  unpleasant  predica- 
ment; if  not  the  oil  will  kill  it. 

Foreign  bodies  in  the  nose. — If  near  enough  to  the  nostril  to  be 
seen  the  body  may  possibly  be  expelled  by  compressing  the  other 
nostril  and  having  the  patient  blow  his  nose  hard.  A  fountain 
syringe  placed  1  foot  above  the  head,  the  nozzle  of  the  syringe  in- 
serted in  the  clear  nostrd  and  the  patient's  face  lookmg  somewhat 
downward,  wUl  cause  the  water  to  gently  flow  in  at  one  side  of  the 
nose  and  out  at  the  other  side,  and  may  dislodge  the  object.  A 
crochet  needle  may  be  gently  tried  as  described  for  the  ear.  All 
these  things  failing  wait  for  the  doctor. 

Foreign  bodies  in  the  throat. — If  the  body  can  be  seen  by  holding 
the  tongue  down  with  a  spoon  or  by  drawing  the  tongue  out  with  a 
towel,  it  can  sometimes  be  hooked  out  by  means  of  a  finger  passed 
well  in.  If  the  body  is  in  the  windpipe,  this  wiU  be  manifested  by 
violent  coughing,  which  may  dislodge  it.  Inverting  the  patient  and 
slapping  his  back  may  be  tried.  If  these  measures  do  not  succeed, 
then  use  every  effort  to  quiet  the  patient,  and  if  practicable  send 
for  a  physician.  If  the  body  is  in  the  gullet  on  the  way  to  the 
stomach,  vomiting  may  bring  it  up,  and  this  can  be  excited  by  tick- 
ling the  throat,  or  using  some  of  the  simple  vomiting  agents  men- 
tioned in  the  chapter  on  poisons  (p.  Ill),  provided  the  patient  can 
swallow.  If  it  is  not  dislodged,  and  is  known  to  be  an  object  without 
sharp  edges,  as  a  coin,  for  instance,  it  is  best  to  mduce  it  to  go  on 
into  the  stomach  by  drmking  water,  eating  bread,  mashed  potatoes, 
or  other  soft  food.  Once  in  the  stomach  the  patient,  usually  a  child, 
should  be  made  to  eat  aU  the  mashed  potatoes  he  can  possibly  hold, 
and  a  large  dose  of  castor  oil  should  follow.  The  potatoes  form  a 
mass  around  the  foreign  body,  and  the  od  usually  pushes  this  mass 
through  the  bowels  without  any  trouble  whatever.  The  stools  or 
passages  should  be  carefully  watched  to  determine  that  the  object 
passes,  and  if  it  does  not,  the  doctor  should  be  consulted  without 

delay. 

BURNS  OR  SCALDS. 

Burns  or  scalds  are  serious  and  dangerous  to  life  in  proportion 
to  the  extent  and  depth  of  the  injury.  A  bum  covermg  a  large 
area  and  producmg  mere  reddening  and  swelling  of  the  skin  is  as 
serious  as  a  burn  one-half  the  size  m  which  the  skin  is  destroyed. 
The  danger  is  from  shock,  from  fever  following  reaction,  from  hem- 
orrhage followmg  sloughmg,  and  from  congestion  and  inflammation 


MEDICAL   HANDBOOK.  •  87 

of  internal  organs.  Burns  of  slight  extent  or  moderate  degree  are 
not  so  dangerous,  and  most  of  the  cases  commonly  met  with  will 
recover.     But  all  cases  require  careful  treatment. 

Treatment. — The  indications  for  treatment  in  these  two  conditions 
are  virtually  the  same  if  the  damage  is  superficial;  and  this  is  usually 
the  case,  the  injuries  being  only  skin-deep.  Blisters  should  be 
pricked  with  a  needle  that  has  been  passed  through  a  flame  several 
times.  This  allows  the  water  to  escape  from  the  blisters,  but  the 
skin  raised  by  the  blisters  should  not  be  removed.  If  the  burning 
agent  is  pitch  or  tar,  and  adheres  to  the  skin,  it  should  not  be  re- 
moved; it  will  come  away  later  with  the  blistered  skm.  Any  bland 
oil,  such  as  sweet  oil,  linseed  oil,  or  vaseline,  forms  a  soothing  appli- 
cation. Ordinary  baking  soda  or  a  saturated  solution  of  soda  in 
water  can  be  used.  The  old  "Carron  oil"  made  of  linseed  oil  and 
lime  water,  half  and  half,  is  excellent,  but  has  an  unpleasant  odor. 
If  lime  water  is  not  at  hand,  it  may  be  obtamed  as  follows:  Quick- 
lime is  first  slaked  by  addmg  to  it  gradually  about  30  times  its  weight 
of  water.  Agitate  durmg  one-half  hour,  allow  the  lime  to  settle,  and 
reject  the  liquid.  Add  to  the  residue  of  lime  about  300  times  its 
weight  of  water,  agitate  frequently  during  the  next  24  hours,  and 
allow  the  lime  to  settle.  The  clear  water  standing  above  the  undis- 
solved lime  is  lime  water. 

The  parts  burned  or  the  entire  body,  except  the  head,  may  be  kept 
immersed  in  tepid  or  warm  water  for  days.  Cream  or  white  of  eggs 
may  be  used,  but  they  are  apt  to  become  offensive  after  24  hours. 
Kerosene  is  an  old  household  remedy.  One  teaspoonful  of  table  salt 
in.  a  pint  of  water  makes  a  solution  that  can  be  employed.  Keep 
the  patient  quiet  and  his  bowels  active.  Pain  or  restlessness  may 
be  relieved  by  laudanum  20  drops,  repeated  in  two  hours  if  necessary. 

If  the  eye  is  red  from  contact  with  the  flames  or  hot  fluid,  sweet 
oil  is  perhaps  the  best  household  remedy  to  drop  m.  A  bandage 
lightly  applied  over  the  eyes  to  keep  out  the  light  will  be  soothing. 

If  the  skin  or  the  eye  is  burned  with  acid,  a  solution  of  baking 
soda  should  be  used  first.  If  the  burning  agent  is  an  alkali,  such  as 
hartshorn  or  lye,  weak  vinegar  or  lemon  juice  should  be  used. 
Sweet  oil  should  be  dropped  in  the  eye  after  such  treatment. 

If  the  patient  has  breathed  the  flame  or  steam,  the  condition  is  apt 
to  be  a  serious  one,  even  though  it  does  not  appear  so  at  once. 
Complete  rest  and  quiet,  an  ice  bag  to  the  chest,  the  giving  of  milk 
and  cream,  haK  and  haK,  if  swallowing  is  possible,  should  be  em- 
ployed. Artificial  respiration,  as  described  elsewhere,  may  be 
applicable  in  some  cases. 

Speaking  generally  of  bums  and  scalds,  a  superficial  bum  covering 
a  large  part  of  the  skin  may  be  more  dangerous  than  a  deep  bilrn  con- 
fined to  a  small  part,  for  reasons  which  it  is  unnecessary  to  discuss  in 


88  .  LIGHTHOUSE   SEEVICE. 

a  book  of  tliis  Mnd.  No  burn  or  scald  should  therefore  be  treatea  as  a 
trivial  matter.  Where  solutions  are  used  the  bandages  should  be 
soaked  in  the  same  before  applying  and  the  solution  should  be  poured 
over  the  bandaged  part  at  frequent  intervals. 

The  scars  resulting  from  bums  and  scalds  always  contract,  and  in 
severe  cases  terrible  deformities  are  produced.  These  may  be  pre- 
vented to  some  extent  by  active  and  passive  motion  and  by  splints. 

RESUSCITATION  FROM  APPARENT  DROWNING. 

In  the  act  of  breathing  the  oxygen  from  the  air  is  absorbed  from 
the  lungs  into  the  blood  vessels  and  purifies  the  blood;  at  the  same 
time  the  impure  matters  picked  up  by  the  blood  in  circulating  through 
the  body  are  filtered  out  by  the  lungs  and  pass  off  to  the  atmosphere 
with  the  breath.  When  a  person  is  under  water  he  can  hold  his 
breath  for  a  short  time,  keeping  out  the  water.  Then  he  swallows 
some  water  into  the  stomach,  and  as  his  strength  fails  water  enters 
the  lungs.  The  water  in  the  stomach  does  no  particular  harm;  but 
that  in  the  lungs  is  of  vital  importance  because  it  stops  breathing, 
causes  poisoning  of  the  system  from  lack  of  purification  of  the  blood, 
and  if  allowed  to  remain  for  any  length  of  time  produces  stoppage  of 
the  heart  and  death. 

The  indications,  therefore,  in  one  apparently  drowned  are  to  remove 
the  vv^ater  from  the  lungs,  to  make  the  patient  breathe,  and  to  stimu- 
late the  weak  heart. 

The  old  method  of  roUing  a  patient  over  a  barrel  to  remove  the 
water  from  the  lungs  is  not  considered  efiicient  by  those  who  have  had 
most  experience.  Inverting  the  patient  by  grasping  his  feet  and 
holding  him  head  down  for  a  few  moments,  at  the  same  time  making 
pressure  on  his  beUy  inward  and  toward  the  chest,  may  remove  part  of 
the  water.  The  chest  is  separated  from  the  belly  by  a  partition  con- 
sisting of  a  thin  flat  muscle,  and  pressure  inward  and  upward  on  the 
beUy  forces  this  partition  up  against  the  lungs,  and  may  mechan- 
ically squeeze  some  water  out  of  the  tubes  in  the  lungs.  Time  should 
not  be  wasted  in  prolonged  efforts  to  remove  the  water,  as  it  is 
important  to  proceed  as  quickly  as  possible  with  artificial  breathing, 
which  will  not  only  squeeze  the  water  out  of  the  lungs  but  will  renew 
respiration  and  revive  the  patient. 

There  are  several  methods  that  have  been  suggested  and  used  for 
inducing  artificial  breathing,  but  to  save  delay  in  selecting  one  the 
layman  should  have  explained  to  him  in  a  book  of  this  kind  one 
method  only,  and  that  one  the  method  that  has  been  accepted  as  the 
best,  namely,  the  Schafer  method.     (See  figs.  36  and  37.)  ^ 

1  The  two  illustrations  on  p.  89  are  reprinted  by  permission  from  a  booklet  entitled  "Rules  for  resusci- 
tation from  electric  shock,"  issued  by  the  National  Electric  Light  Association. 


MEDICAL    HANDBOOK.  89 

Scliafer's  description  of  his  metliod,  as  quoted  by  Crile,  is  as  follows, 
except  that  the  technical  words  and  expressions  have  been  ehminated 
and  ordinary  ones  that  will  be  understood  by  a  layman  substituted: 

The  subject,  whether  a  drowned  person  or  not,  is  allowed  to  lie  prone,  i.  e.,  face 
downward,  no  preliminary  manipulation  of  the  tongue  being  requii'ed.     The  operator 


Fig.  36. 


kneels  or  squats  either  across  or  on  one  side  of  the  subject,  facing  the  head,  and  places 
his  hands  close  together  flat  upon  the  back  of  the  subject  over  the  loins,  the  fingers 
extending  over  the  lowest  riljs.  By  now  leaning  forward  upon  the  hands,  keeping  the 
elbows  extended,  the  weight  of  the  operator's  body  is  brought  to  bear  upon  the  subject, 
and  this  not  only  compresses  the  lower  part  of  the  chest  but  also  the  belly  upon  the 
ground,  the  pressure  being  fairly  equally  distributed.     The  result  of  this  is  that  not 


Fig.  37. 

only  is  the  chest  diminished  in  extent  from  before  back,  but,  owing  to  the  pressure 
which  is  communicated  to  the  belly,  the  belly  contents  are  compressed  and  tend  to 
force  the  muscle  partition  between  the  chest  and  belly  up,  so  that  the  chest  is  dimin- 
ished in  capacity  from  above  down.  This  is  no  doubt  the  reason  why  the  pressure 
method  when  applied  with  the  subject  Ijdng  on  his  belly  is  more  effective  than  when 
applied,  as  by  Howard,  with  the  subject  Ijdng  on  his  JDack.     The  pressiu-e  is  applied 


90  LIGHTHOUSE   SERVICE. 

not  violently  but  gradually  diuing  about  three  seconds,  and  is  then  released  by  the 
operator  swinging  his  body  back,  but  without  remo^dng  his  hands.  The  elasticity  of 
the  chest  and  belly  causes  these  to  resume  their  original  dimensions  and  air  passes  in 
through  the  windpipe.  After  two  seconds  the  process  is  again  commenced,  and  is 
continued  in  the  same  way,  the  operator  swinging  his  body  forward  and  backward  once 
every  five  seconds,  or  about  twelve  times  a  minute,  without  any  violent  effort  and 
with  the  least  possible  exertion.  This  last  condition,  viz,  the  absence  of  muscular 
exertion,  other  than  that  involved  in  swinging  forward  and  backward,  renders  it  pos- 
sible to  continue  the  process  without  fatigue  for  an  indefinite  time.  It  can  further  be 
carried  out  unaided  by  a  woman  almost  as  well  as  a  man,  by  children  upon  children; 
it  hardly  requires  to  be  taught — a  simple  demonstration  sufficiently  teaches  it  to  a 
large  audience.  Its  advantages  in  drowning  cases,  over  any  other  method  which 
involves  the  position  on  the  back,  are  sufficiently  obvious — for  with  it  there  is  no  risk 
of  obstruction  by  water  or  slime  or  the  contents  of  the  stomach,  which  can  not  accu- 
mulate in  the  throat,  but  must  come  away  l^y  the  mouth;  and  the  tongue,  in  place 
of  falling  back,  as  in  the  position  on  the  back,  falls  forward  and  is  iinable  to  produce 
obstruction. 

Crile  says  in  regard  to  this  method:  "Schafer's  method  should  be 
used  in  all  cases  in  the  absence  of  medical  assistance  or  outside  of  a 
hospital,  and  even  in  a  hospital  in  the  absence  of  immediate  surgical 
aid."  He  further  says:  "Simple  artificial  respiration  is  the  only  hope 
in  drowning  and  other  accidents  occurrmg  when  professional  help  is 
not  at  hand."  When  the  patient  is  able  to  swallow,  a  smaU  cup  of 
black  coffee  or  hot  milk  with  a  tablespoonful  of  whisky  may  be 
given,  and  repeated  a  few  times  at  intervals  of  an  hour.  If  he  does 
not  swallow  well,  and  an  ordmary  syringe  is  available,  the  coffee 
and  whisky  may  be  mjected  into  the  bowel  and  left  there,  but  the 
effect  is  slower. 

It  is  scarcely  necessary  to  state  that  the  patient  should  be  removed 
to  a  warm  place,  the  wet  clothing  removed,  and  the  lower  parts  of 
the  body  covered  and  artificially  warmed.  Pending  the  arrival  of 
the  doctor  the  patient  should  be  closely  watched,  and  if  signs  of 
collapse  appear,  renewed  efforts  should  be  made.  Prolonged  and 
systematic  rubbing  of  the  skin  and  Icneading  of  the  muscles  wiU 
assist  in  promoting  the  circulation  of  the  blood. 

INSTRUCTIONS  FOR  SAVING  DROWNING  PERSONS  BY  SWIMMING  TO 

THEIR  RELIEF. 

1.  When  you  approach  a  person  drowning  in  the  water,  assure 
him,  with  a  loud  and  firm  voice,  that  he  is  safe. 

2.  Before  jumping  m  to  save  him,  divest  yom-self  as  far  and  as 
quickly  as  possible  of  all  clothes;  tear  them  off,  if  necessary;  but  if 
there  is  not  time,  loose  at  all  events  the  foot  of  your  drawers,  if  they 
are  tied,  as,  if  you  do  not  do  so,  they  fill  with  water  and  drag  you. 

3.  On  swimmmg  to  a  person  in  the  sea,  if  he  be  struggling  do  not 
sei^e  him  then,  but  keep  off  for  a  few  seconds  till  he  gets  quiet,  for  it 
is  sheer  madness  to  take  hold  of  a  man  when  he  is  struggling  in  the 
water;  and  if  you  do,  you  run  a  great  risk. 


MEDICAL   HAISTDBOOK.  91 

4.  Then  get  close  to  liim  and  take  fast  hold  of  the  hau-  of  his  head, 
turn  him  as  quickly  as  possible  onto  his  back,  give  him  a  sudden 
pull,  and  this  will  cause  him  to  float,  then  throw  yourself  on  your 
back  also  and  swim  for  the  shore,  having  hold  of  liis  hair,  you  on 
your  back  and  he  also  on  his,  and,  of  course,  his  back  to  your  stomach. 
In  this  way  you  will  get  sooner  and  safer  ashore  than  by  any  other 
means,  and  you  can  easily  thus  swim  with  two  or  three  persons; 
the  wiiter  has  even,  as  an  experiment,  done  it  with  four,  and  gone 
with  them  40  or  50  yards  in  the  sea.  One  great  advantage  of  this 
method  is  that  it  enables  you  to  keep  your  head  up  and  also  to  hold 
the  person's  head  up  you  are  trying  to  save.  It  is  of  primary 
importance  that  you  take  fast  hold  of  the  hair  and  throw  both  the 
person  and  yourself  on  your  backs.  After  many  experiments,  it  is 
usually  found  preferable  to  aU  other  methods.  You  can  in  this 
manner  float  nearly  as  long  as  you  please,  or  until  a  boat  or  other 
help  can  be  obtained. 

5.  It  is  believed  there  is  no  such  thing  as  a  death  grasp;  at  least 
it  is  very  unusual  to  witness  it.  As  soon  as  a  drowning  man  begins 
to  get  feeble  and  to  lose  his  recollection,  he  gradually  slackens  his 
hold  until  he  quits  it  altogether.  No  apprehension  need,  therefore, 
be  felt  on  that  head  when  attempting  to  rescue  a  drowning  person. 

6.  After  a  person  has  sunk  to  the  bottom,  if  the  water  be  smooth, 
the  exact  position  where  the  body  lies  may  be  known  by  the  air 
bubbles,  which  will  occasionally  rise  to  the  surface,  allowance  being, 
of  course,  made  for  the  motion  of  the  water,  if  in  a  tideway  or 
stream  which  will  have  carried  the  bubbles  out  of  a  perpendicular 
course  in  rising  to  the  surface.  Oftentimes  a  body  may  be  regained 
from  the  bottom  before  too  late  for  recovery  by  diving  for  it  in  the 
direction  indicated  by  these  bubbles. 

7.  On  rescuing  a  person  by  diving  to  the  bottom  the  hair  of  the 
head  should  be  seized  by  one  hand  only  and  the  other  used  in  con- 
junction with  the  feet  in  raising  yourself  and  the  drowning  i:)erson 
to  the  surface. 

8.  If  in  the  sea,  it  may  sometimes  be  a  great  error  to  try  to  get  to 
land.  If  there  be  a  strong  ''outsetting"  tide,  and  you  are  swimming 
either  by  yourself  or  having  hold  of  a  person  who  can  not  swim,  then 
get  on  your  back  and  float  tiU  help  comes.  Many  a  man  exhausts 
himself  by  stemming  the  billows  for  the  shore  on  a  back-going  tide 
and  sinks  in  the  effort,  when  if  he  had  floated  a  boat  or  other  aid 
might  have  been  obtained. 

9.  These  instructions  apply  ahke  to  all  circumstances,  whether  as 
regards  the  roughest  sea  or  smooth  water. 

RESUSCITATION  FROM  GAS  POISONING. 

In  this  condition  there  is  nothmg  to  block  the  entrance  of  air  to 
the  tubes  in  the  lungs  as  there  is  in  drowning,  but  the  blood  has 


92  LIGHTHOUSE  see^t:ce. 

absorbed  so  mucb  of  the  poisonous  gas  that  the  life  is  tlireatened, 
and  the  lungs  and  heart  gradually  fail.  The  indications  are  to 
remove  the  patient  to  a  good  atmosphere,  with  plenty  of  fresh  air, 
and  employ  artificial  respiration  as  described  under  drowning. 
Rubbing  and  the  stimulants  mentioned  in  the  foregoing  are  helpful. 
It  may  not  be  out  of  place  to  state  here  that  persons  who  have 
attempted  drowning,  gas  poisoning,  etc.,  with  suicidal  intent  are 
very  apt  to  make  another  effort  at  the  first  opportunity.  It  is 
therefore  necessary  that  means  to  this  end  be  kept  away  from  them, 
and  that  moral  encouragement  be  extended  by  all  possible  means. 

RESUSCITATION  FROM  ELECTRIC  SHOCK.i 

An  accidental  electric  shock  usually  docs  not  kiU  at  once,  but  may 
only  stun  the  victim  and  for  a  while  stop  his  breathing. 

The  shock  is  not  likely  to  be  immediatelj^  fatal  because — (a)  The 
conductors  may  make  only  a  brief  and  imperfect  contact  with  the 
body,  (b)  The  skin,  unless  it  is  wet,  offers  high  resistance  to  the 
current. 

Hope  of  restoring  the  victim  lies  in  prompt  and  continued  use  of 
artificial  respiration.  The  reasons  for  this  statement  are:  (a)  The 
body  continuously  depends  on  an  exchange  of  air,  as  showm  by  the 
fact  that  we  must  breathe  in  and  out  about  15  times  a  minute. 
(b)  If  the  body  is  not  thus  repeatedly  supplied  with  air,  suffocation 
occurs,  (c)  Persons  whose  breathing  has  been  stopped  by  electric 
shock  have  been  restored  after  artificial  respiration  has  been  con- 
tinued for  approximately  two  hours. 

Instructions. — FoUoid  these  instructions  even  if  victim  appears  dead: 

I.  Break  the  circuit  immediately. 

1.  With  a  single  cjuick  motion  separate  the  victim  from  the  live 
conductor.  In  so  domg  avoid  receiving  a  shock  yourself.  Many 
have,  by  their  carelessness,  received  injury  m  trying  to  cUsconnect 
victims  of  shock  from  live  conductors. 

Observe  the  following  precautions :  (a)  Use  a  dry  coat,  a  dry  rope, 
a  dry  stick  or  board,  or  any  other  dry  nonconductor  to  move  either 
the  victim  or  the  wire,  so  as  to  break  the  electrical  contact.  Beware 
of  using  metal  or  any  moist  material.  The  victun's  loose  clothing, 
if  dry,  may  be  used  to  pull  him  away;  do  not  touch  the  soles  or  heels 
of  his  shoes  while  he  remains  in  contact — the  nails  are  dangerous. 
(b)  If  the  body  must  be  touched  by  your  hands,  be  sure  to  cover  them 
with  rubber  gloves,  mackintosh,  rubber  sheeting,  or  dry  cloth;  or 
stand  on  a  dry  board  or  some  other  dry  insulating  surface.  If  pos- 
sible, use  only  one  hand.  If  the  victim  is  conducting  the  current  to 
ground,  and  is  convulsively  clutching  the  five  conductor,  it  may  be 

1  Taken  from  "Rules  for  rcsusci: alion  from  electric  shock,"  issued  by  the  National  Electric  Light 
Association. 


MEDICAL    HANDBOOK.  93 

easier  to  shut  off  the  current  by  lifting  him  than  by  leaving  him  on 
the  ground  and  trying  to  break  his  grasp. 

2.  Open  the  nearest  switch,  if  that  is  the  quickest  way  to  break 
the  circuit. 

3.  If  necessary  to  cut  a  live  wire,  use  an  ax  or  a  hatchet  with  a  dry 
wooden  handle,  or  properly  insulated  pliers. 

II.  Attend  instantly  to  the  victim's  breathing.  Use  the  Schafer 
method  of  artificial  respiration  as  described  under  treatment  of  the 
apparently  drowned  (p.  89).  Burns  of  the  skin  should  be  treated  as 
described  for  ordmary  burns.  Warmth  to  the  body,  gentle  rubbing, 
and  later  light  stimulants  and  hot  milk  if  the  subject  can  swallow, 
are  indicated,  but  do  not  give  any  liquids  whatever  by  mouth  until 
the  subject  is  fuUy  co"nscious. 

BITES  AND  STINGS  OF  POISONOUS  ANIMALS  OR  INSECTS. 

Bite  of  dog  or  cat. — This  is  usually  a  punctured  wound;  that  is, 
the  teeth  enter  without  tearing  the  flesli,  and  the  wound  almost 
entirely  closes,  thereby  preventing  drainage  and  mcreasing  the 
danger.  Sucking  the  wound  hard  repeatedly  and  washing  out  the 
mouth  with  hot  water  may  remove  some  of  the  poison.  Squeezing 
is  less  effective.  The  wound  should  then  be  burned  either  with  car- 
bolic acid  or  a  red-hot  iron  carried  to  the  bottom,  and  the  skin  about 
the  wound  should  be  scrubbed  with  alcohol  or  other  aiitiseptic.  A 
drain  of  several  strands  of  boiled  sewing  silk  should  be  pushed  into 
the  bottom  of  the  wound,  and  an  antiseptic  dressing  or  boded  cloth 
apphed  over  the  wound.  The  patient  should  then  be  taken  to  the 
nearest  place  where  the  Pasteur  treatment  to  prevent  hydrophobia 
or  rabies  can  be  secured.  The  hygienic  laboratory  of  the  United 
States  Public  Health  Service  in  Washington,  D.  C,  administers  this 
treatment  without  cost. 

If  the  animal  is  known  to  be  mad,  this  treatment  is  imperative 
and  whether  mad  or  not,  it  is  a  very  wise  precaution,  and  relieves  the 
anxiety  of  the  patient.  Do  not  kill  the  dog  or  cat  for  the  purpose  of 
rubbing  the  hair  of  the  tail  on  the  wound.  It  wiU  do  no  good,  and 
you  wdl  never  know  whether  or  not  the  animal  was  mad.  Capture 
the  animal,  watch  it,  and  if  it  shows  any  signs  of  bemg  mad  kill  it 
and  send  the  body  to  the  nearest  laboratory  for  exammation. 

Snake  bite. — In  snake  bite  a  handkerchief,  rope,  or  the  Spanish 
windlass,  described  on  page  52,  should  be  applied  above  tlie  part 
bitten  if  tliis  be  on  a  limb,  and  the  part  should  be  immediately  and 
repeatedly  sucked  to  remove  as  much  of  the  poison  as  possible. 
Washing  the  mouth  several  times  with  hot  water  will  prevent  any 
danger  from  tliis  source.  The  windlass  must  be  loosened  every  20 
minutes  for  .the  reasons  given  on  page  53.  It  should  be  again 
tightened  after  2  minutes.     The  intention  of  this  treatment  is  to  pre- 


94  LIGHTHOUSE    SEE  VICE. 

vent  more  than  a  small  portion  of  the  poison  entering  the  circulation 
at  one  time.  This  procedure  should  not  be  continued  for  more  than 
3  hours.  Great  care  should  be  taken  to  see  that  too  much  blood  is 
not  cut  off  from  the  limb  as  gangrene  v/ill  result.  The  bite  should  be 
burned  with  carbohc  acid  or  a  red-hot  iron  passed  into  the  bottom 
of  the  wound.  A  strong  solution  (saturated)  of  permanganate  of 
potash  poured  into  the  wound  or  injected  around  the  wound  may 
have  some  effect. 

Bites  and  stings  of  insects. — In  a  spider  bite,  a  mosquito  bite,  or 
a  bee  sting,  baking  soda  moistened  and  placed  on  the  part  tends  to 
reheve  and  shorten  the  pain.  Hartshorn  and  water,  haK  and  half, 
have  the  same  effect.  Ice  or  cold  water,  or  very  hot  applications  of 
water  may  help  to  reduce  the  swelling  after  the  pain  has  subsided. 

Tick  bite. — The  tick,  which  is  instrumental  in  spreading  Rocky 
Mountain  spotted  fever,  should  be  removed  from  the  skin  by  means 
of  hartshorn,  kerosene,  turpentine,  or  carbolized  vaseline,  which 
prevent  the  head  remaining  in  the  skin. 

Lice. — Three  kinds  of  lice  infest  human  beings,  the  pediculosis 
capitis  or  head  louse,  the  pediculosis  corporis  or  body  louse,  and  the 
pediculosis  pubis  or  crab  louse.  They  cause  itching  and  burning, 
and  in  some  cases  severe  inflammation  of  the  skin  with  the  formation 
of  sores.  Crusts,  interspersed  with  bleeding  areas,  may  be  present. 
The  body  louse,  and  possibly  the  head  louse,  transmits  typhus  fever 
and  perhaps  other  diseases  from  one  person  to  another. 

Every  effort  should  be  made  to  free  the  body  from  lice  and  their 
eggs  if  one  should  be  so  unfortunate  as  to  become  infested  with  these 
insects.  The  head  louse  is  destroyed  by  washing  the  hair  with  kero- 
sene, care  being  taken  that  it  does  not  run  down  over  the  face  or 
neck.  Gasoline  is  as  efficient  as  kerosene,  but  it  should  not  be 
used  as  its  inflammability  is  much  greater  than  kerosene.  The  dan- 
ger of  burning  a  patient  in  case  either  of  these  preparations  is  em- 
ployed should  be  borne  in  mind,  and  the  patient  should  be  outdoors 
at  the  time  of  application  and  remain  outside  until  the  hair  becomes 
dry.  Several  applications  at  intervals  of  two  or  three  days  are 
required,  as  the  nits,  or  eggs,  are  hard  to  kill.  These  may  some- 
times be  combed  from  the  hair  with  a  fine-toothed  comb.  The  body 
louse  exists  principally  in  the  clothing,  so  this  should  be  boiled  or 
baked.  If  this  is  impossible,  the  clothing  and  especially  the  seams 
should  be  ironed  with  a  hot  iron.  An  efficient  method  is  to  soak 
the  clothing  in  gasoline,  or  the  vapor  of  gasoline  may  be  forced 
through  them.  Another  less  expensive  method  is  to  put  the  clothes 
for  half  an  hour  in  a  soapy  solution  to  which  2  per  cent  of  trichlo- 
rethylene  has  been  added.  The  best  application  to  the  body  is  a 
solution  made  by  mixing  one  part  of  gasoline  with  three  parts  of 
vaseline.     This  preparation  is  noninflammable  under  working  condi- 


MEDICAL    HANDBOOK.  95 

tions.  ''Crabs"  are  Idlled  by  the  application  of  mercmial  or  blue 
ointment.  This,  however,  is  a  nasty  treatment,  and  the  same  results 
can  be  obtained  by  washing  with  bichloride  of  mercury  solution,  one 
part  to  five  hundred  of  water. 

EFFECTS  OF  COLD— FROSTBITE. 

Severe  cold  depresses  the  action  of  the  heart — suspends  the  circu- 
lation. These  effects  are  first  noticed  in  the  eare,  nose,  fingers,  and 
toes.  Numbness  and  tinghng  are  the  first  symptoms,  then  loss  of 
sensation.  If  not  too  long  exposed,  the  circulation  may  be  restored 
by  proper  treatment.  But  if  the  exposure  is  long  continued,  or  if  the 
cold  is  very  intense,  the  parts  are  hopelessly  frozen  and  gangrene  will  be 
the  result.  The  parts  may  look  all  right  for  a  few  days  after  reaction, 
and  then  become  discolored,  bluish,  and  finally  black.  Another  effect 
of  extreme  cold  is  an  overpowering  sense  of  drowsiness,  but  to  lie  down 
under  such  circumstances  and  go  to  sleep  is  almost  certain  death. 

Treatment  of  frostbites. — 1.  Do  not  bring  the  patient  to  the  fu"e 
nor  bathe  the  parts  in  warm  water. 

2.  If  snow  be  on  the  ground,  or  accessible,  take  a  woolen  cloth  in 
the  hand,  place  a  handful  of  snow  upon  it,  and  gently  rub  the  frozen 
part  until  the  natural  color  is  restored.  In  case  snow  is  not  at  hand, 
bathe  the  part  gently  with  a  woolen  cloth  in  the  coldest  fresh  water 
obtainable — ice  water  if  practicable. 

3.  In  case  the  frostbite  is  old  and  the  skin  has  turned  black  or 
begun  to  scale  off,  do  not  attempt  to  restore  its  vitahty  by  friction, 
but  apply  a  little  cotton,  after  which  wrap  the  part  loosely  in  flannel. 

4.  In  the  case  of  a  person  apparently  dead  from  exposure  to  cold, 
friction  should  be  applied  to  the  body  and  the  lower  extremities,  and 
artificial  respiration  practiced  as  in  cases  of  the  apparently  drowned. 
As  soon  as  the  circulation  appears  to  be  restored,  administer  strychnia 
sulphate  one-fortieth  grain.  Even  if  no  signs  of  life  appear,  friction 
should  be  kept  up  for  a  long  period,  as  instances  are  on  record  of 
recovery  after  several  hours  of  suspended  animation. 

RUPTURE. 

The  usual  ruptm-e  encountered  by  the  layman  appears  in  the  groin. 
If  it  comes  on  suddenly  for  the  first  time,  there  is  generally  a  history 
of  heavy  lifting  or  some  other  unusual  exertion,  followed  by  consid- 
erable pain  and  the  appearance  of  a  swelling.  This  sweUing  as  a  rule 
contains  a  loup  of  bowel.  The  bowel  may  shp  back  readily  and  the 
swelling  subside  for  the  time  being  if  the  patient  lies  down.  Some- 
times, however,  the  bowel  does  not  slip  back,  and  this  is  particularly 
true  if  it  has  been  down  before. 

Treatment. — Placing  the  patient  in  a  hot  bath  and  gently  manip- 
ulating the  swelling  may  cause  the  bowel  to  return  to  its  proper 
place  in  the  belly.     In  the  manipulation  it  should  be  remembered 


96  LIGHTHOUSE    SEEVICE. 

that  the  bowel  is  a  dehcate  structure,  and  that  it  has  come  down 
through  a  very  small  opening.  The  last  part  to  descend  should  be 
the  first  part  pushed  back.  If  a  few  minutes'  manipulation  does 
not  restore  the  bowel,  place  the  patient  in  bed  with  an  ice  bag  on 
the  swelling  and  secure  the  services  of  a  doctor  if  possible,  because 
there  is  danger  of  mortification  of  the  bowel. 

ANTISEPSIS,  ANTISEPTICS,  AND  THE  DRESSING  OF  WOUNDS. 

We  are  surrounded  at  all  times  by  very  minute  organisms  capable 
of  producing  various  diseases  or  complications.  They  are  sometimes 
called  germs,  and  more  vulgarly  called  ''bugs."  The  latter  name  is 
incorrect,  as  the  germs  belong  to  the  vegetable  and  not  the  animal 
kingdom.  In  first-aid  work  the  germs  that  particularly  interest  us 
are  those  that  get  into  wounds  and  infect  them,  causing  pus  or 
"matter"  and  sometimes  blood  poison. 

Definitions.— When  these  complications  arise  the  process  is  known 
as  "sepsis."  ''Antisepsis,"  therefore,  refers  to  the  question  of  re- 
moving or  killing  the  germs,  and  "antiseptics"  are  the  medicines  or 
other  agents  used  in  accomplishing  these  purposes.  This  explana- 
tion is  made  for  the  reason  that  it  is  necessary  to  use  the  terms 
"antisepsis"  and  "antiseptics"  in  this  chapter,  there  being  no  com- 
mon names  quite  as  expressive.  There  is  another  term,  "asepsis," 
used  by  doctors,  which  refers  to  the  condition  where  all  germs  have 
been  removed  or  killed,  but  this  is  a  condition  that  does  not  often 
obtain  in  first-aid  work  administered  by  a  lajonan,  and  therefore  will 
not  be  further  discussed.  We  frequently  hear  a  person  say  that  he 
has  good  blood  because  when  he  cuts  himself  the  wound  heals  quickly. 
This  is  apt  to  give  him  a  false  sense  of  security  and  cause  him  to 
neglect  the  precautions  that  should  be  taken.  Some  of  the  worst 
cases  of  "sepsis"  and  blood  poison  occur  in  strong  healthy  men  who 
have  had  no  previous  trouble  in  the  healing  of  wounds.  Germs  are 
always  present  on  the  skui  and  can  be  demonstrated  by  laboratory 
methods.  They  can  only  be  seen  by  a  microscope  of  high  power. 
A  patient  may  have  taken  a  hot  soap  bath  before  being  injured,  but 
his  skin  is  not  surgically  clean,  and  antiseptics  are  therefore  em- 
ployed to  destroy  the  germs  that  remain. 

The  dresser's  hands. — The  one  who  is  to  make  the  dressing  should 
see  that  his  own  hands  are  surgically  clean  hefore  he  attempts  to 
clean  or  "sterilize"  the  wound;  otherwise  he  is  apt  to  transfer  germs 
from  his  hands  to  the  wounds  or  to  the  dressings.  The  hands 
should  be  scrubbed  with  a  nailbrush,  hot  water,  and  soap.  Then 
the  finger  nails  should  be  cleansed  and  the  hands  scrubbed  again, 
A  good  way  to  clean  the  finger  nails  is  to  rake  them  across  a  cake  of 
soap,  fiUing  the  space  under  each  nail  with  the  soap.  As  this  is 
removed  with  a  pocketknife  the  dirt  comes  away  with  it.  Then 
after  the  second .  scrubbing  the  hands  should  be  soaked  and  rubbed 
in  some   antiseptic  solution   and  not   dried.     The  skin   about  the 


MEDICAL  HANDBOOK.  97 

wound  should  now  be  scrubbed  with  the  nailbrush  and  soap;  and 
if  it  is  a  hahy  part,  the  hair  should  be  shaved  for  some  distance  on 
aU  sides  of  the  wound  before  the  scrubbing.  The  wound  and  the 
parts  about  it  should  then  be  thoroughly  cleansed  with  the  antiseptic 
solution;  and  a  cloth,  preferably  one  that  has  been  boiled,  soaked  ui 
the  antiseptic  solution,  laid  over  the  wound,  and  bound  there  with  a 
bandage. 

Alcohol. — The  antiseptic  that  is  most  apt  to  be  at  hand  or  most 
easily  obtained  is  alcohol.  It  creates  a  burning  sensation  when  ap- 
phed  to  a  wound,  but  tliis  is  a  small  matter  if  it  prevents  infection 
in  the  wound.  Where  alcohol  can  not  be  obtained,  whisky  or  brandy, 
which  contain  about  50  per  cent  of  alcohol,  may  be  obtainable.  Some 
experiments  have  recently  been  made  in  the  San  Francisco  Federal 
Laboratory  by  officers  of  the  United  States  Pubhc  Health  Service 
showing  that  whisky  and  brandy  are  very  good  antiseptics. 

Iodine. — Tmcture  of  iodine,  usually  known  by  the  layman  as  simply 
'iodine,"  is  one  of  the  best  antiseptics  known  at  the  present  time. 
Its  power  is  far  greater  if  apphed  to  a  dry  surface  than  to  a  wet 
surface.  The  burning  sensation  produced  hi  the  wound  does  not 
last  long.  A  dry  sterile  dressing  over  it  is  preferable  to  a  wet  dress- 
ing, as  the  wet  dressiag  lessens  its  power  and  is  apt  to  bhster  the 
skin.     Too  much  iodine  may  also  bhster. 

Bichloride  of  mercury. — ^An  antiseptic  much  used  in  hospitals  is 
bichloride  of  mercury  or  corrosive  sublimate.  It  is  not  apt  to  be  on 
hand  in  the  ordinary  household  or  camp,  but  is  mentioned  as  one 
of  the  agents  to  be  kept  in  the  first-aid  chest.  It  can  be  purchased  in 
tablet  form,  and  each  tablet  added  to  a  pint  of  water  makes  a  solution 
of  a  certain  strength.  The  strength  that  is  safest  for  the  layman  to 
use  is  1  part  of  bichloride  of  mercury  to  5,000  parts  of  water.  This 
is  an  excellent  antiseptic.  It  is  deadly  poison,  however,  if  taken 
internally,  and  should  therefore  be  handled  with  care. 

Peroxide  of  hydrogen. — Peroxide  of  hydrogen  has  become  a  favor- 
ite and  popular  antiseptic.  Its  power  in  this  regard  is  weak,  but  it 
is  a  cleansing  agent  and  can  be  employed  as  a  dressing  in  the  absence 
of  anything  better.  It  tends  also  to  stop  oozing  of  blood  in  a  wound 
where  no  large  vessels  are  cut. 

Carbolic  acid. — The  pure  carbolic  acid  should  be  obtained  if  pos- 
sible, and  as  a  dressing  for  wounds  should  be  made  into  a  solution 
of  1  part  of  carbohc  acid  to  100  parts  of  water. 

Turpentine. — Turpentine  is  used  by  veterinary  surgeons  in  dress- 
ing wounds  of  horses,  and  probably  depends  largely  for  its  virtue 
upon  its  antiseptic  power,  which  is  considerable.  It  can  be  poured 
into  a  wound,  but  only  a  small  amount  should  be  placed  on  the 
dressing,  as  it  may  bhster.  If  sterile  gauze  is  available  for  the  dress- 
ing, it  wiU  be  better  not  to  pour  any  turpentine  on  the  gauze  but  to 
trust  to  that  which  has  been  pom-ed  into  the  wound. 

98908°— 15 7 


98  LIGHTHOUSE   SERVICE. 

Sterile  dressings. — There  can  be  purchased  for  the  first-aia  cnest 
various  kinds  of  sterile  dressings ;  that  is,  dressings  that  have  had  all 
germs  killed  by  exposure  to  heat.  Sterile  gauze  comes  packed  in  a 
bottle  in  the  form  of  a  roll,  and  it  unrolls  as  pieces  are  drawn  out 
and  cut  off.  From  a  theoretical  standpoint  the  gauze  is  no  longer 
sterile  after  the  package  has  once  been  opened;  but  for  practical 
first-aid  work  it  answers  the  purpose  if  each  piece  cut  off  is  carefully 
unfolded  with  clean  hands  and  the  inside  of  the  piece  apphed  next 
to  the  wound.  It  is  advisable  to  buy  small  packages,  so  that  a  new 
one  will  be  opened  from  time  to  time. 

How  to  sterilize  dressings. — The  one  most  efficient  and  always 
available  method  of  sterihzing  dressings  is  by  boding  for  10  minutes 
in  plain  water,  which,  from  a  practical  standpoint,  kills  all  germs 
that  can  infect  a  wound.  If  a  dry  dressing  is  desirable,  it  can  be 
placed  in  a  pan  in  a  hot  oven  for  15  or  20  minutes  and  removed  just 
as  it  is  beginning  to  be  scorched.  If  several  layers  of  a  sterile  dressing 
are  apphed  directly  over  a  wound  and  lap  around  it  at  aU  sides, 
it  is  not  absolutely  necessary  that  the  additional  dressing  material 
placed  over  this  be  sterile,  although  it  is  desirable. 

Sterilizing  instruments,  etc. — If  scissors,  knitting  needles,  ordi- 
nary needles,  or  other  metal  instruments  or  implements  are  necessary 
in  dressing  a  wound,  they  should  be  boiled  in  water  for  10  minutes, 
or  can  be  passed  through  a  flame  several  times,  or  some  alcohol  can 
be  poured  on  the  instrument  and  then  set  on  fixe  with  a  match. 
Actual  fire  is  apt  to  remove  the  temper  from  the  instrument  much 
more  easily  than  boihng,  for  which  reason  boihng  is  preferable. 

BANDAGING. 

Bandaging  is  an  art,  and  it  is  not  necessary  in  first-aid  work 
that  the  bandage  be  an  object  of  beauty  if  it  accompHshes  the  purpose 
for  which  it  ^.s  intended,  but  at  the  same  time  the  average  first-aid 
bandage  is  torn  from  an  old  sheet,  pillowcase,  or  shirt;  the  material  is 
limited  in  quantity,  and  if  the  same  result  can  be  achieved  by  half 
the  bandage  material  apphed  in  a  systematic  manner,  the  other 
half  wiU  be  available  for  the  second  dressing. 

Mushn  forms  a  very  good  bandage  and  can  be  readily  torn  in  strips. 
Hospitals  now  almost  universally  use  gauze,  which  is  a  bleached 
cheesecloth,  known  sometimes  to  the  trade  as  buttercloth.  It  is 
hght,  stretches  so  as  to  apply  itself  to  a  part,  and  is  not  expensive. 
Some  grades  of  gauze  tear  fairly  well;  others  do  not.  Gauze  bandages 
put  up  for  sale  are  roUed  in  bolts  about  18  inches  wide,  of  any  desired 
length,  and  then  cut  with  a  sharp  knife  directly  through  the  roll. 
This  leaves  a  clean,  smooth  edge  to  the  bandage.  Each  one  is 
wrapped  in  paper  to  preserve  this  edge.  The  most  convenient 
bandage,  if  but  one  size  is  to  be  purchased,  is  3  inches  wide  and  5 
yards  long.     There  are  only  a  few  locations  in  the  body  where  a 


MEDICAL  HANDBOOK.  99 

wider  bandage  is  necessary,  and  if  a  narrower  one  is  desired,  the 
rolled  bandage  can  be  cut  through  with  a  pocket  knife.  Flannel  is 
used  where  it  is  desired  to  exert  pressure,  the  bandage  being  wrapped 
snugly  several  times  around  the  part;  it  is  also  serviceable  in  excluding 
light,  as  in  an  eye  bandage. 

Crinoline,  used  by  ladies  to  stiffen  dress  skirts,  is  a  loosely  woven 
cotton  fabric  filled  with  starch.  One  grade  has  a  crossbar  pattern 
of  heavier  threads;  the  other  is  made  throughout  of  the  same  size 
thread.  The  latter  is  better  for  bandages,  as  it  stretches  more  evenly. 
If  a  grade  can  be  secured  that  contains  a  sufficient  amount  of  starch, 
it  can  be  wet  for  a  few  moments,  then  applied,  and  when  dry  forms 
an  excellent  starch  dressing  that  \viU  hold  its  position  perfectly.  If 
the  crinoline  does  not  contain  sufficient  starch  for  the  pm-jDose, 
it  should  be  roUed  very  loosely,  with  quite  an  opening  left  at  the  core, 
and  then  dropped  into  a  utensil  of  hot  starch  and  gently  stirred 
about  and  compressed  with  a  spoon  or  stick.  To  prepare  the  starch 
for  this  purpose  use  a  double  boiler,  such  as  oatmeal  is  cooked  in, 
if  available,  and  into  a  quart  of  cold  water  drop  a  double  handful  of 
granulated  starch,  then  bring  the  water  to  a  boil,  stirring  constantly. 
When  the  starch  is  a  thoroughly  consistent  gummy  mass,  drop  in 
the  bandage,  and  by  manipulation  cause  the  starch  to  reach  all 
parts  of  it.  The  utensil  can  then  be  cooled  somewhat  by  standing 
it  in  a  vessel  of  cold  water,  and  the  bandage  is  ready  to  apply;  it 
should  not  be  stretched,  however,  because  it  contracts  in  drying  and 
will  be  too  tight.  If  parts  of  the  bandage  do  not  contain  enough 
starch,  a  Uttle  can  be  taken  from  the  vessel  and  rubbed  on  these  parts 
during  the  application.  To  strengthen  the  whole  bandage  and  to 
insure  a  smooth  finish,  some  more  starch  can  be  added  to  the  outside. 
As  a  starch  bandage  wiU  stick  to  the  hairs  on  the  skin,  it  is  best  to 
first  apply  a  plain  bandage  and  the  starch  bandage  over  this.  If  a 
broken  leg,  for  instance,  is  to  be  transported  some  distance,  a  padded 
pasteboard  splint,  covered  with  a  starch  bandage,  well  dried,  wHl 
insure  that  the  bones  will  not  move  during  the  trip.  If  crinohne  is 
not  at  hand,  gauze  or  musHn  can  be  used  for  the  starch  bandage, 
but  they  are  not  as  satisfactory. 

Plaster  of  Paris.— Plaster  of  Paris  bandages  can  be  purchased 
ready-made,  each  one  in  a  tin  box  to  protect  it  from  moisture.  If 
such  a  bandage  is  to  be  made,  crinoline  is  preferable  to  gauze.  The 
bandage  is  either  drawn  through  a  pan  containing  dry  plaster  (dental 
plaster  being  best)  and  rolled  as  it  emerges  from  the  pan,  or  the 
bandage  can  be  stretched  out  on  a  table,  the  plaster  sprinkled  on,  and 
rubbed  smooth  with  a  spoon  or  knife,  and  then  the  rolling  done. 
Fresh  plaster  is  absolutely  necessary,  as  luinpy  plaster  can  not  be 
used.  These  bandages  should  be  roUed  loosely;  otherwise  the  wetting 
will  not  reach  the  center.  Lukewarm  water  should  be  used,  and 
the  bandage  simply  rolled  on,  not  stretched,  or  it  wiU  be  too  tight. 


100 


LIGHTHOUSE   SERVICE. 


A  layer  of  cotton  or  other  soft  material  should  always  be  placed 
around  the  lunb  before  the  plaster  bandage  is  apphed  to  prevent  the 
constriction.  A  httle  plaster  added  to  the  outside  before  it  dries 
insures   a  smoother  finish   and  strengthens   the   dressing.     Salt  or 

alum  added  to  the  water  has- 
tens the  setting  and  glue  de- 
lays it,  but  in  first-aid  work  it 
is  l)est  to  use  plain  water. 

Method    of    applying. — ^The 

bandaging  of  a  leg  will  be  taken 

as  an  illustration  of  the  proper 

method  of  applying  a  bandage, 

.  , ,       I  \      \  I         /  w    (      ^'^  *^®  ^^S  requires  such  treat- 

\)j/\/\       ,\        I         f  \J      ment  as  frequently,  perhaps,  as 

any  part  of  the  body.  We  will 
consider  first  a  muslin  band- 
age, such  as  would  be  made  by 
tearing  up  a  sheet.  A  bandage 
3  inches  wide  is  a  convenient 
size.  If  the  wound  or  other 
injury  is  above  the  ankle,  it  is 
far  better  to  begin  the  bandage 
at  the  foot  and  work  up ;  oth- 
erwise the  foot  is  very  apt  to 
swell.  This  is  particularly  im- 
portant if  for  any  reason  it  is  necessary  to  apply  the  bandage  rather 
tightly.  The  bandage  should  never  be  placed  around  a  hmb  under 
a  splint.  Thick  layers  of  cotton  or  other  resihent  substance  should 
be  put  between  the  splint  and  the  leg,  and  the  bandage  put  on  outside 
of  the  splint.  The  leg  tapers,  and  a  mus- 
Hn  bandage  can  not  therefore  be  apphed 
by  simply  passing  around  and  around  the 
limb  as  we  work  up.  It  must  be  reversed; 
that  is,  turned  over  sharply  at  a  certain 
pomt  each  time  it  passes  around  the  leg. 
If  the  dresser  is  right-handed,  he  should 
stand  at  the  patient's  feet  and  always 
apply  the  bandage  from  left  to  right,  the 
direction  that  the  hands  of  a  clock  turn. 
The  end  of  the  bandage  should  be  placed 
across  the  instep  (fig.  38),  the  tip  end  be- 
mg  left  long  enough  to  extend  to  the  back 
of  the  heel,  for  a  reason  to  be  presently 

explained.  The  bandage  should  be  simply  roUed  around  the  part  at 
all  times,  and  the  hand  should  not  get  far  away  from  the  leg;  other- 
wise the  long  piece  of  unrolled  bandage  will  wrinkle.     Pass  the  first 


Fig.  38. 


Fig.  39. 


MEDICAL  HANDBOOK. 


101 


Fig.  40. 


tui-n  across  the  instep,  then  under  the  sole,  and  once  dhectly  around 
the  foot  just  back  of  the  toes.  As  the  bandage  comes  up  from  under 
the  sole  the  second  time,  pass  it  again  across  the  instep,  making  a 
letter  X  with  the  part  first  apphed 
(fig.  39).  The  bandage  now  passes 
back  of  the  ankle  and  emerges  where 
the  start  was  made  and  near  the  loose 
tip  end.  This  tip  end  is  now  folded 
directly  on  itself  (fig.  40)  and  laid 
across  the  instep,  where  it  is  locked 
and  held  fast  by  the  next  turn  of  the 
bandage.  The  bandage  now  crosses 
the  instep  again  parallel  with  the  first 
strip  and  covering  the  upper  half  of  it. 
On  emerging  from  the  sole  it  follows 
the  line  of  the  second  arm  of  the  X 
previously  mentioned,  covers  the  up- 
per half  of  it,  and  passes  to  the  back 
of  the  ankle  (fig.  41).  Two  or  three 
turns,  depending  upon  the  shape  of 
the  leg,  are  now  made  directly  around 
the  ankle,  each  one  concealing  the  up- 
per half  of  the  previous  one,  and  at 
this  point  the  expanding  outline  of  the  calf  requires  that  the  re- 
versing process  begin.  The  bandage  is  passed  diagonally  upward 
this  time  instead  of  straight  around.  The  tip  of  the  left  index  finger 
is  placed  on  the  upper  edge  of  the  bandage  as 
it  crosses  the  shin  bone,  the  bandage  is  un- 
rolled only  2  or  3  inches,  and  then  turned 
directly  over,  using  the  finger  tip  as  a  pivot 
(fig.  42).  The  bandage  now  passes  around  the 
leg,  and  when  it  emerges  from  behind  it  fol- 
lows the  fine  of  the  previous  turn,  conceahng 
the  upper  half  of  it,  and  another  reverse  is 
made  over  the  shin  bone.  When  the  curva- 
ture of  the  calf  is  thus  covered  a  few  circular 
turns  just  below  the  knee  complete  the  band- 
age (fig.  43),  and  it  can  then  be  pinned,  pref- 
erably by  two  safety  pins,  placed  up  and 
down  the  leg,  one  above  the  other;  ordinary  pins  can  be  used, 
or  the  last  foot  of  the  bandage  can  be  spUt,  one  end  passed  either 
way  around  the  leg  and  the  two  ends  tied.  If  pins  are  used,  they 
should  be  inserted  before  the  surplus  bandage  material  is  cut  off, 
as  the  unoccupied  hand  can  hold  the  bandage  snug  and  smooth 
during  the  pinning.     If  the  bandages  available  are  short,  and  more 


Fig.  41. 


102 


LIGHTHOUSE   SEEVICE. 


than  one  is  necessary,  the  first  end  of  the  second  one  is  made  to  lap 
over  the  last  end  of  the  first  one  for  several  inches,  and  the  next 
turn  of  the  bandage  secures  them  in  position. 


Fig.  42. 


Fig.  43. 


Fig.  44. 


If  a  gauze  bandage  is  available  for  this  dressing,  it  is  applied  some- 
what differently.  A  gauze  bandage  should  not  be  reversed;  in  the 
first  place  it  is  not  necessary,  and  in  the  second  place  it  does  not 

reverse  well  owing  to  its  soft,  yielding  na- 
ture. The  bandaging  follows  the  same  lines 
described  above  to  and  including  the  circular 
turns  at  the  ankle.  When  the  expansion  of 
the  lower  part  of  the  calf  is  reached,  the 
bandage  is  applied  in  what  is  known  as  a 
"figure  of  eight"  around  the  calf.  Begin- 
ning at  the  uppermost  of  the  ankle  turns  the 
bandage  is  passed  diagonally  upward  across 
the  shin  bone  to  a  point  just  below  the  back 
of  the  knee  (fig.  44).  Then  one  turn  is 
taken  around  the  leg  below  the  knee  to 
take  the  kink  out  of  the  bandage,  and  as  it 
emerges  from  the  back  of  the  leg  the  second 
time  it  passes  diagonally  down  the  front 
of  the  leg  across  the  shinbone,  making  an 
X  with  the  part  passing  up  the  other  side  (fig.  45).  It  now 
passes  behind  the  leg  and  comes  out  at  a  point  where  in  contin- 


Fig.  45. 


MEDICAL   HANDBOOK. 


103 


\ 


uing  diagonally  upward  again  it  will  be  parallel  to  and  conceal  the 
upper  half  of  the  previous  strip  laid  in  the  same  direction.  Upon 
reaching  the  point  below  the  knee  another  circular  turn  is  made  to 
remove  the  kink,  and  then  the  bandage  passes  diagonally  downward 
parallel  to  and  concealing  the  upper  half  of  the  last  strip  there 
applied.  This  figure  of  eight  is  continued  until  the  caH 
is  covered,  when  a  few  circular  turns  complete  the  dressing 
(fig.  46). 

Special  bandages. — In  the  absence  of  suitable  bandages 
a  piece  of  muslin  can  be  cut  or  torn  into  various  forms 
to  fit  different  parts  of  the  body. 

Esmarch  triangular  bandage. — The  Esmarch  bandage 
is  a  triangular  piece  of  muslin  52  inches  across  the  long 
side  and  26  inches  from  the  middle  of  the  long  side  to  the 
angle  opposite.  It  is  said  to  form  a  part  of  the  equip- 
ment of  every  German  soldier,  and  on  it  are  printed  figures 
showing  the  various  uses  to  which  it  may  be  put.  It  is 
illustrated  in  figure  47.^  A  sheet  or  piUowcase  cut  to  the 
same  size  and  shape  answers  every  purpose. 

Head  bandage. — A  handkerchief  knotted  at  the  four 
corners  and  slipped  over  the  head,  as  shown  in  figure  48, 
wiU  hold  a  dressing  on  the  scalp.  If  it  shows  a  tendency 
to  slip,  it  can  be  retained  in  position  by  another  hand- 
kerchief passing  xmder  the  chin  and  tied  over  the  head 
(fig.  49). 

Jaw  bandage. — In  a  broken-jaw  case  a  handkerchief  passing  under 
the  chin  and  tied  over  the  head  will  hold  the  bones  fairly  well  for  a 
short  time.  A  second  handkerchief  passing  in  front  of  the  chin  and 
tied  at  the  back  of  the  head  assists  (fig.  50).  A  better  way  to  band- 
age the  jaw  is  to  tear  a  strip  of  muslin  36  inches  long  and  6  inches 
wide.  Each  end  is  split  to  a  point  near  the  center.  The  upper 
strip  is  now  passed  in  front  of  the  chin  and  tied  at  the  back  of  the 
head  (fig.  51),  and  the  lower  strip  is  then  brought  under  the  chin 
and  tied  over  the  head  (fig.  52).  If  the  jaw  is  to  be  held  in  place 
several  days  before  a  doctor  can  be  reached,  it  is  best  to  cut  a  piece 
of  pasteboard  10  inches  long  and  4  inches  wide  and  slit  it  at  the 
ends  (fig.  53).  This  is  then  moistened  and  molded  to  the  chin  (fig. 
54).  This  mold  when  padded  and  held  in  place  by  the  split  band- 
age, or  preferably  by  a  starch  bandage  applied  along  the  same  lines, 
will  hold  the  jaw  very  well  until  surgical  aid  can  be  secured. 

Chest  or  belly  bandage. — In  a  burn  or  scald  on  the  chest,  belly,  or 
back  it  sometimes  taxes  the  ingenuity  of  an  expert  to  keep  a  suit- 


FlG.  46. 


1  The  Esmarch  triangular  bandage  shown  on  p.  104  is  reproduced  by  courtesy  of  Johnson  &  Johnson, 
New  Brunswick,  N.  J. 


104 


LIGHTHOUSE    SERVICE. 


MEDICAL  HANDBOOlto  105 


EXPLANATION  OF   NUMBERS  SHOWN  ON  FIGURES  IN  ILLUSTRATION  OF  ESMARCH 

BANDAGE  (fig.  47). 

1.  Broken  leg  below  knee  and  at  ankle.     Umbrella  used  as  splint. 

2.  Broken  arm — upper  arm  and  at  wrist.     Rough  wood  splints  used. 

3.  Hand  bandage.     (See  also  No.  7.) 

4.  Wide  sling  for  arm. 

5.  Upper-arm  bandage.     (See  also  No.  18.) 

6.  Tbigb  bandage. 

7.  Hand  bandage.     (See  also  No.  3.) 

8.  Eye  bandage. 

9.  Scalp  bandage.  * 

10.  Chin  and  face  bandage. 

11.  Knee  bandage. 

12.  Wrist  and  fore-arm  bandage.    Rough  wood  splints  used. 

13.  Bandage  for  back. 

14.  Elbow  bandage. 

15.  Foot  bandage. 

16.  Splint  and  bandage  for  broken  thigh  and  ankle. 

17.  Splint  and  bandage  for  broken  leg. 

18.  Arm  bandage. 

19.  Chest  bandage,  rear  view. 

20.  Chest  bandage,  front  view. 

21.  Skull  bandage. 

22.  Forehead  bandage. 

23.  Heel  bandage. 

24.  Narrow  sling  for  arm. 
26.  Fore-arm  bandage. 
29.  Throat  bandage. 

31.  Hip  bandage. 

32.  Shoulder  bandage. 

33.  Stopping  artery  bleeding  of  arm  with  hand  pressure. 

34.  Stopping  artery  bleeding  of  arm  with  tourniquet. 

35.  Stopping  artery  bleeding  of  leg  with  hand  pressure. 

36.  Stopping  artery  bleeding  of  leg  with  tourniquet. 

37.  38.  Removing  foreign  substance  from  eye. 


106 


LIGHTHOUSE   SERVICE. 


Fig.  4S. 


Fig.  49. 


Fig.  50. 


Fig.  51. 


MEDICAL  HANDBOOK. 


107 


able  dressing  in  place.  A  towel  or  strip  of  muslin  passed  around 
the  body  and  pinned  in  front  can  be  held  in  place  by  two  strips  of 
bandage  passing  over  the  shoulders  as  suspenders  (fig.  55).     If  this 


Fig.  53. 


Fig.  52. 


Fig.  54. 


bandage  shows  a  tendency  to  slip  up  from  below,  another  strip  can 
be  pinned  to  the  lower  edge  in  front,  the  strip  split,  the  two  pieces 
carried  between  the  thighs,  separated,  and  pinned  to  the  lower  part  of 

the  bandage  at  the  back.  Another  good 
method  is  to  make  a  vest  by  cutting  two 
armholes  in  a  strip  of  muslin  (fig.  56). 
After  passing  the  patient's  arms  through 
the  holes  the  vest  is  pinned  up  the  front, 
and  the  slack  over  the  shoulders  is  taken 
up  by  other  pins  (fig.  57).  This  can  also 
have  strips  passing  between  the  thighs. 

Bandage    for    crotch.  —  A    triangular 
piece    of    muslin    applied    as    a    diaper 


Fig.  55.  Fig.  56. 

will  answer  in  some  cases.  A  more  comfortable  bandage  can  be 
made  of  two  strips  of  muslin  about  4  inches  wide  and  60  inches 
long.     At  the  end  of  one  strip  cut  several  slits  (fig.  58).     Thread 


lOB 


LIGHTHOUSE   SERVICE, 


the  second  strip  through  these  slits  to  its  center,  making  a  T-shaped 
bandage.  Place  the  cross  of  the  T  under  the  patient's  back  at  the 
waist  line  and  tie  the  top  part  of  the  T  around  the  waist.  Split  the 
vertical  end  of  the  T,  bring  the  two  ends  between  the  thighs  from 
behind  forward,  and  tie  them  to  the  waistband. 

Finger  stall. — Figure  15  shows  the  pattern  for  a  finger  stall,  as 
well  as  the  completed  stall,  this  being  a  convenient  bandage  for  keep- 
ing a  dressing  on  the  finger  or  thumb. 

TRANSPORTATION  OF  INJURED. 

It  seems  almost  umiecessary  to  mclude  a  chapter  on  this  subject, 
because  when  a  person  is  injured  his  friends  Avill  find  some  way  of 
transporting  him  to  the  doctor,  the  method  being  prompted  by  the 


Fig.  57. 


FiCt.  5S. 


facilities  available,  coupled  with  their  o^\ti  good  sense.  At  the 
same  time  a  few  hints  may  add  to  the  comfort  of  the  patient  during 
transportation. 

If  it  is  but  a  short  distance  the  injured  person  has  to  be  moved 
he  may  be  carried  in  one  of  several  ways,  depending  largely  upon 
the  nature  of  the  injury.  Carrying  on  one's  back,  as  practiced  by 
schoolboys,  will  answer  in  some  cases.  If  two  persons  stand  at 
either  side  of  the  patient,  and  join  hands  under  the  knees  and  under 
the  shoulders,  the  patient  at  the  same  time  steadjdng  himself  by 
passing  his  arms  around  the  necks  or  shoulders  of  the  carriers,  he 
can  be  transported  in  comfort  quite  a  distance.  Again,  let  the 
two  carriers  face  one  another ;    each  one  grasps  his  own  left  wrist 


MEDICAL  HANDBOOK. 


109 


with  his  right  hand;  then  the  two  persons  approach,  and  each  with 
his  unoccupied  hand  grasps  the  unoccupied  wrist  of  the  other,  form- 
ing a  chair  (fig,  59).  If  the  patient  is  faint  and  requires  support,  a 
back  may  be  made  to  this  chair  as  follows:  Assistant  No.  1  grasps 
his  own  left  wrist  with  his  right  hand,  assistant  No.  2  grasps  the 
unoccupied  wrist  of  No.  1  with  his  left  hand,  while  the  left  hand  of 
No.  1  grasps  the  left  wrist  of  No.  2.  This  makes  a  three-handed 
chair  and  leaves  the  right  arm  of  No.  2  disengaged;  he  passes  this 
arm  across  the  shoulders  of  No.  1,  forming  a  back  to  the  chair  (fig.  60). 
One  assistant  can  pass  his  arms  through  the  armpits  of  the  patient 
and  clasp  his  hands  over  the  patient's  chest,  while  the  second  assist- 
ant stands  between  the  patient's  legs  and  supports  them  with  his 
arms,  both  assistants  facing  toward  the  patient's  feet. 


Fig.  59. 


Fig.  60. 


A  chair  can  be  utilized  in  carrying  a  patient  in.  the  following 
manner:  Pass  a  pole  under  the  center  of  the  seat  from  side  to  side, 
nail  it  fast,  and  allow  it  to  protrude  for  about  a  foot  at  either  side. 
Pass  another  pole  across  the  back  of  the  chair  from  side  to  side  at 
a  convenient  height,  and  lash  it  fast,  allowing  it  to  protrude  at 
either  side  about  2  feet.  The  two  assistants  stand  one  at  either 
side  of  the  chau*.  The  hands  that  are  next  to  the  chair  grasp  the 
pole  passing  under  the  seat,  while  the  outside  arms  are  thrown 
back  of  the  upper  pole,  steadying  it  (fig.  61).  A  wide  chair  can 
also  be  used  by  naihng  two  poles  under  the  seat,  these  extending 
several  feet  in  front  and  behind. 

A  stretcher  can  be  constructed  of  two  poles  and  a  blanket  or 
piece  of  a  tent.     Roll  the  poles  into  the  borders  of  the  blanket  or 


110 


LIGHTHOUSE    SERVICE. 


Fig.  61. 


canvas  for  several  inclies,  and,  make  them  fast  by  twine  passed 
tkrough  at  intervals.  The  poles  are  cut  long  enough  to  protrude 
at  the  ends  as  handles.  If  it  is  a  case  that  will  be  more  comforta- 
ble on  a  flat  stretcher  than  on  one  that  wraps  around  the  patient 
like  a  hammock,  the  poles  can  be  held  apart  by  cutting  two  sticks, 

notchmg  them  at  the  ends,  and 
lashing  them  in  place,  one  at 
the  head  and  one  at  the  foot. 
Straps  attached  to  the  handles 
and  passing  over  the  shoulders 
of  the  carriers  help  to  relieve  the 
strain.  A  door,  shutter,  or  lad- 
der can  be  used  for  transportation 
over  a  short  distance,  but  they  are 
very  uncomfortable  and  difficult 
to  carry.  If  there  are  a  number 
of  assistants,  a  stick  passed  under 
the  head  and  another  under  the 
foot  of  such  a  stretcher,  protrud- 
ing from  either  side,  will  provide 
for  four  carriers.  A  stretcher 
has  been  suggested,  made  of  two 
poles  and  two  coats;  the  poles 
are  passed  through  the  sleeves  of  the  coats  and  the  coats  are  then 
buttoned.  This  will  answer  if  the  patient  is  not  heavy.  It  is  said 
that  some  patients  ride  easier  if  the  carriers  do  not  try  to  keep  step ; 
this  is  a  matter  that  can  be  safely  left  to  the  decision  of  the  patient 
himself. 

If  a  horse  is  available,  but  no  vehicle  can  be  obtamed,  the  old 
Indian  method  may  be  adopted  of  lashing  two  long  poles  to  the  sides 
of  the  horse  and  letting  them  drag  behind;  the  blanket  or  canvas 
being  attached  between  the  poles. 

POISONS. 

The  scope  of  this  book  does  not  permit  an  extended  discussion  of 
the  many  agents  that  may  cause  poisoning  m  the  human  being,  but 
a  brief  outline  will  be  given  of  the  general  management  of  such  cases 
where  the  nature  of  the  poison  is  unknown,  and  also  a  few  rules 
regarding  the  treatment  m  poisonmg  by  the  more  common  poisons.^ 

DIRECTIONS  TO  BE  FOLLOWED  IN  CASE  OF  POISONING. 

Send  for  the  doctor  immediately,  if  practicable,  and  if  the  nature 
of  the  poison  is  known,  have  the  messenger  inform  the  doctor  so 

1  Solutions  containing  poisonous  substances  should  be  kept  in  bottles  marted  "poison"  or  in  basins— 
never  in  pitchers,  cups,  or  utensils  employed  in  cooking.  The  bottle  or  basin  contaiuing  the  poison  should 
be  placed  upon  a  high  shelf  where  it  can  not  readily  be  mistaken  for  a  harmless  substance. 


MEDICAL  HANDBOOK.  Ill 

that  he  may  conie  prepared.  If  the  poison  is  unknown,  but  the 
bottle  from  which  it  was  taken  is  found,  save  the  bottle,  as  it  may- 
help  in  case  of  legal  investigation.  If  the  poison  has  been  taken 
with  suicidal  mtent  and  the  patient  survives,  the  same  caution  is 
applicable  that  was  mentioned  imder  drowning,  gas  poisoning,  etc. 
Warmth  to  the  body,  light  stimulation,  and  encouragement  are 
indicated. 

In  treating  cases  of  poisoning  first  give  an  antidote,  if  one  is 
available;  second,  promote  early  and  repeated  vomiting  to  remove 
the  bulk  of  the  poison;  third,  give  something  that  will  help  envelope 
the  poison  left  in  the  stomach  and  prevent  its  further  absorption 
into  the  system;  fourth,  remedy  the  damage  that  has  been  done,  so 
far  as  this  is  possible. 

The  following  "general  antidote,"  which  should  be  prepared  as 
needed,  should  be  given  when  poisoning  by  any  of  the  poisons  men- 
tioned in  this  book  occurs  or  if  the  poison  is  unknown:  Magnesia,  2 
teaspoonfuls;  charcoal,  2  teaspoonfuls;  tannic  acid,  1  teaspoonful. 
These  dry  powders  should  be  kept  thoroughly  mixed  in  the  above 
proportions  in  an  air-tight  bottle  and  when  needed  one  heaping 
tablespoonful  should  be  mixed  with  a  cupful  of  water.  This  is  one 
adult  dose  and  should  be  repeated. 

Should  there  be  no  tannic  acid  on  hand,  a  cupful  of  very  strong 
tea  or  tea  of  oak  bark  will  take  the  place  of  the  tannic  acid  and  water. 

Vomiting  or  puking  may  be  induced  by  tickling  the  throat  with 
a  feather  or  pushing  the  finger  dov^oi  the  throat,  or  by  the  adminis- 
tration of  one  of  the  following  emetics  by  mouth: 

Mustard. — One  tablespoonful  stirred  to  a  cream  with  a  cupful  of 
tepid  water. 

Common  salt. — One  tablespoonful  to  a  cupful  of  tepid  water.  Not 
very  certain  as  an  emetic. 

Alum. — Two  teaspoonfuls  to  a  cupful  of  tepid  water.  This  is  a 
rather  feeble  emetic. 

Ipecac. — Give  1  tablespoonful  of  the  sirup  of  ipecac  in  a  cupful  of 
tepid  water.     Repeat  once  if  necessary. 

The  doses  recommended  throughout  this  article  are  for  adults; 
the  amount  should  be  proportionately  small  for  children. 

UNKNOWN  POISON. 

Give  "general  antidote"  followed  by  emetics  or  raw  whites  of 
several  eggs;  or  in  their  absence  milk,  or  flour  and  water.  The 
white  of  egg,  particularly,  is  inclined  to  pick  up  part  of  the  poison 
left  in  the  stomach  and  hold  it  until  the  patient  can  be  made  to 
vomit  again.  If  the  body  is  limp  and  respiration  is  feeble,  tea  or 
coffee  can  be  given  as  a  stimulant,  and  warmth  applied  to  the  body 
with  massage  or  rubbing  will  tend  to  support  the  circulation. 


112  LIGHTHOUSE   SERVICE. 

OPIUM,  LAUDANUM,  PAREGORIC,  MORPHINE,  CODEINE,  HEROIN, 

INDIAN  HEMP. 

Give  the  "general  antidote,"  or  potassium  permanganate  (one- 
third  teaspoonful  dissolved  in  a  pint  of  water — no  undissolved  crys- 
tals should  remain  in  the  fluid),  or  hydrogen  peroxide  (2  teaspoon- 
fuls  in  a  pint  of  water),  or  borax,  or  bakuig  soda  (about  1  table- 
spoonful  to  the  pint  of  water),  followed  by  an  emetic.  Whites  of 
eggs  and  considerable  quantities  of  strong  tea  or  strong  black  coffee 
should  be  given,  or  if  unable  to  swallow,  mject  the  coffee  into  the 
bowel  with  a  syringe. 

Give  sweet  spirit  of  niter  (1  teaspoonful  in  water  three  times  a 
day)  to  aid  excretion  by  kidneys. 

Keep  patient  awake  by  shaking,  striking  with  wet  towel,  applying 
cold  water  over  face  and  chest,  or  forced  walking. 

Wines  and  hquors  must  not  be  given. 

^¥hen  respiration  becomes  slow  and  irregular,  artificial  respiration 
should  be  employed,  the  same  as  is  used  to  restore  the  partially 
drowned. 

The  patient  should  be  put  in  bed  and  warmth  apphed,  and  care- 
fully watched  for  some  time  after  the  dangerous  symptoms  have 
subsided. 

ARSENIC,   RATSBANE,    PARIS   GREEN,    "ROUGH   ON  RATS,"  FOWLER'S 

SOLUTION. 

The  best  antidote,  if  the  ingredients  can  be  obtained,  is  prepared 
by  mixing  a  teaspoonful  of  magnesia  with  a  cup  of  water,  adding  2 
tablespoonfuls  of  tincture  of  iron,  stirring  well,  and  giving  the  whole 
in  one  dose;  or  the  "general  antidote"  may  be  given,  followed  by 
emetics,  raw  whites  of  eggs  mixed  with  water,  or  large  drinks  of  hot 
greasy  water,  or  salt  and  water  (tablespoonful  to  pmt),  or  strong  tea. 
Magnesia  may  be  given  in  tablespoonful  doses  mixed  with  water. 
Lime  water  in  large  quantities  is  of  some  value,  and  in  its  absence 
limis  which  may  be  scraped  from  the  walls  or  ceiling  and  mixed  with 
water  may  be  administered. 

Protect  stomach  with  2  tablespoonfuls  of  sweet  oil,  gruel,  starch, 
mucilage,  flaxseed  tea,  or  elm-bark  tea.  Castor  oil  (1  ounce)  should 
be  given  after  vomiting  occurs  even  though  the  bowel  movements  are 
frequent. 

Pain  can  possibly  be  lessened  by  hot  bottles  to  the  stomach  and 
bowels. 

Keep  patient  warm  with  artificial  heat  or  extra  garments,  and 
give  strong  coffee  to  avert  collapse. 


MEDICAL  HANDBOOK.  113 

STRYCHNINE,   NDX  VOMICA   (DOG  BUTTON),   FISH  BERRIES,   IGNATIA 

BEAN. 

Give  "general  antidote"  or  charcoal  (1  tablespoonful)  or  strong 
tea  followed  by  an  emetic,  then  doses  of  bromide  of  soda  or  potash 
(one-fourth  of  a  teaspoonful  in  water)  repeated  every  hour  until 
three  or  four  doses  have  been  taken.  Several  whiffs  of  ether  may  be 
inhaled  from  a  handkerchief  at  the  beginning  of  a  spasm. 

Give  sweet  spirit  of  niter  (1  teaspoonful  in  water  three  times  a 
day). 

FoUow  by  a  purge  of  Epsom  salts  or  any  other  saline  cathartic 
that  is  at  hand. 

Artificial  respiration  should  be  employed  the  same  asisusedtojestore 
the  partially  drowned  (pp.  89-90).  Remove  the  patient  to  a  dark- 
ened room  and  keep  as  quiet  as  possible ;  avoid  any  sudden  noises. 

BICHLORIDE  OF  MERCURY  (CORROSIVE  SUBLIMATE). 

Promote  vomiting,  if  not  already  present,  by  giving  mustard  in 
water.     Do  not  use  salt  as  an  emetic. 

Give  raw  whites  of  eggs  in  water  or  milk  or  give  milk  or  mucilage 
in  abundance.  In  absence  of  eggs,  chop  up  raw,  lean  meat  finely 
and  diffuse  through  water  or  milk  and  give.  It  is  necessary  that 
vomiting  be  induced  after  the  eggs,  milk,  or  meat  are  given,  as  the  mix- 
ture formed  of  these  substances  will  be  absorbed  if  allowed  to  remain. 

The  ''general  antidote,"  strong  tea,  and  later  flour  and  water, 
barley  water,  or  flaxseed  tea,  or  elm-bark  tea  may  be  given. 

Borax  in  water,  about  a  tablespoonful  to  the  pint  of  water,  is 
recommended,  but  is  of  doubtful  value. 

Stimulate  with  strong  coffee  if  necessary. 

ACID  POISON— ACETIC,  MURIATIC,  NITRIC,  SULPHURIC,  ETC. 

Give  no  emetic. 

Give  "general  antidote, "  large  drinks  of  water  (or  milk)  with  chalk, 
whiting,  borax,  magnesia,  or  baking  soda,  or  wood  ashes,  or  strong 
soapsuds;  plaster  from  the  wall  may  be  given  in  emergency;  olive 
oil,  raw  whites  of  eggs  beaten  up  with  water,  and  later  flaxseed  tea,, 
elm-bark  tea,  gruel,  starch,  mucilage  freely. 

Laudanum  (20  drops)  may  be  given  if  there  is  much  pain. 

CARBOLIC  ACID  AND  CRESOL  AND  COAL  TAR  DISINFECTANTS 

GENERALLY. 

Give  alcoholic  liquors  (whisky,  brandy,  etc.)  or  equal  parts  of 
alcohol  and  water  freely  to  dissolve  the  poison.  Produce  vomiting  to 
get  rid  of  the  alcoholic  mixture.  In  the  absence  of  alcoholic  liquors, 
give  vinegar,  soapsuds,  or  raw  whites  of  eggs  in  water.  Give  solu- 
tion of  Epsom  or  Glauber  salt  or  sodium  phosphate  well  diluted  to 
hasten  elimination  of  acid  that  may  have  entered  the  circulation. 
98908°— 15 8 


114  LIGHTHOUSE   SERVICE. 

Do  not  give  oils  or  glycerin. 

]\iilk,  gruel,  flaxseed  tea,  or  elm-bark  tea  may  then  be  given.  Hot 
applications  to  extremeties.  For  collapse  give  strong  coffee.  Apply 
artificial  respiration  if  breathing  stops. 

ALKALI  POISONS— LYE,  HARTSHORN,  PEARLASH,  ETC. 

Assist  vomiting  with  large  drinks  of  tepid  water. 

Give  vinegar,  lemon  juice  or  orange  juice,  hard  cider,  whites  of 
eggs  beaten  with  water. 

Follow  by  sweet  oH,  milk,  gruel,  barley  water,  flaxseed  tea,  or 
elm-bark  tea. 

PTOMAINE  POISONING  FROM  FISH. 

The  symptoms  of  ptomaine  poisoning  are  practically  the  same  as 
those  included  under  the  head  of  ."Cholera  morbus"  (p.  38). 

"General  antidote,"  emetics,  copious  drinks  of  strong  tea,  repeat 
emetic,  then  castor  oil  (2  tablespoonfuls)  should  be  given.  Continue 
treatment  as  given  for  cholera  morbus, 

A  LIST  OF  DON'TS. 

Don't  fail  to  send  for  the  doctor.     He  knows  best. 

Don't  leave  the  patient  in  order  to  go  for  the  doctor  if  there  is 
anyone  you  can  send.  He  may  need  your  moral  encouragement  if 
nothing  more. 

Don't  get  excited.  An  appearance  of  agitation  on  your  part  wiU 
discourage  the  patient. 

Don't  hold  an  injured  person  on  his  feet,  nor  require  him  to  sit  in  a 
chair.  He  will  be  better  off  and  less  apt  to  faint  if  he  lies  down, 
preferably  with  the  head  low. 

If  you  have  a  first-aid  chest,  and  a  bottle  of  medicine  is  exhausted, 
don't  wait  until  you  need  it  again  before  having  the  bottle  filled. 

Don't  put  your  fingers  on  a  wound.  They  are  covered  with  germs, 
and  you  will  almost  surely  infect  the  wound. 

Don't  use  a  spider  web  or  a  quid  of  tobacco  on  a  wound.  They  are 
filthy,  do  no  good,  and  are  very  apt  to  infect  the  wound.  The  same 
thing  is  true  to  a  less  extent  in  regard  to  salves  of  various  kinds. 

Don't  place  cotton  next  to  a  wound.  Always  keep  at  least  one 
layer  of  gauze  or  boiled  cloth  between  the  cotton  and  the  raw  surface. 
The  cotton  sticks  to  the  wound  and  is  very  difficult  to  remove. 

Don't  apply  bandages  too  tightly. 

Don't  remove  a  dressing  to  see  how  a  wound  looks.  Let  the  doctor 
do  that. 

Don't  sit  down  at  the  bedside  and  discuss  with  the  callers  all  of  the 
horrible  accidents  you  ever  heard  of.  Your  conversation  will  not  be 
appreciated  by  the  patient. 


INDEX. 


Acetic  acid,  antidote  for 113 

Acid  poison,  antidote  for 113 

Alcohol 97 

Alkali  poisons,  antidote  for 114 

Ankle: 

Dislocation 78 

Sprain 80 

Antidotes  for  poisons Ill 

Antisepsis 96 

Antiseptics 96 

Appendicitis .' 40 

Arm,  fracture 64,65 

Arsenic,  antidote  for 112 

Articles  for  medicine  chest 6 

Back,  broken 63 

Bandaging 98 

Bichloride  of  mercm-y 97 

Antidote  for 113 

Bites 93 

Bleeding 51 

Boils 35 

Bones,  broken 57 

Bronchitis 27 

Bruises 84 

Burns _ .  86 

Carbolic  acid 97 

Antidote  for 113 

Carron  oil,  formula 87 

Chancre  (chancroid) 46 

Chest,  injury 63 

Children,  doses  for 7 

Cholera  morbus 38 

Clap  (gonorrhea) 48 

Cleanliness  of  person 11 

Coal-tar  disinfectant,  antidote  for 113 

Codeine,  antidote  for 112 

Colds 27 

Effects  of 95 

Colic 39 

Collar  bone: 

Dislocation 77 

Fracture 66 

Consumption 28 

Contusions 84 

Corrosive  sublimate,  antidote  for 113 

Coughs 27 

Cramps,  beat 32 

Cresol,  antidote  for 113 

Delirium  tremens 31 

Diarrhea 37 

Diet 11 

Diphtheria 24 

Disinfecting  solutions 10 

Dislocations 73 


Dog  button,  antidote  for 113 

Dressings  for  wounds 96 

Drowning  persons: 

Eesuscitation  of 88 

Swimming  to  relief  of 90 

Drugs,  list 6 

Dysentery 36 

Ear,  foreign  body  in 84 

Eating 11 

Elbow,  dislocation 75 

Electric  shock,  resuscitation  from 92 

Erysipelas 34 

Eye,  foreign  body  in 84 

Fainting 35 

Fever: 

Malarial 13 

Rheumatic 43 

Scarlet 22 

Typhoid 29 

Fingers: 

Dislocation 75 

Fracture 63 

First-aid  rules 51 

Fish  berries,  antidote  for 113 

Fish,  ptomaine  poison  from 114 

Flies 10 

Foot,  fracture 73 

Forearm,  fracture 64 

Fowler's  solution,  antidote  for 112 

Fractures: 

Compound 60 

Simple 57 

Frostbite 95 

Gas  poisoning,  resuscitation  from 91 

Gonorrhea 48 

Gonorrheal  rheumatism 44 

Hartshorn,  antidote  for 114 

Headache 33 

Heat,  effects  of 32 

Hemorrhage 51 

Heroin,  antidote  for 112 

Hip,  dislocation 79 

Ignatia  bean,  antidote  for 113 

Indian  hemp,  antidote  for 112 

Injm'ed  persons,  transportation 108 

Iodine 97 

Jaw,  fracture 61 

Knee: 

Dislocation 78 

Sprain... 80 

Kneecap,  fracture 71 

Laudanum,  antidote  for 112 

Leg,  fracture 72 

Lice 94 

115 


116 


ISTDEX. 


Lye,  antidote  for 114 

Malarial  fever 13 

Measles 16 

Medicines,  care  of 7 

Mediciaes  and  suppUes,  list  of 6 

Morphiae,  antidote  for 112 

Mosquitoes 10 

Mouth,  care  of 11 

Mumps 26 

Muriatic  acid,  antidote  f^r 113 

Nitric  acid,  antidote  for 113 

Nose: 

Foreign  body  in S4 

Fracture 62 

Nosebleed 56 

Nux  vomica  (dog  button),  antidote  for 113 

Opium,  antidote  for 112 

Paragoric,  antidote  for 112 

Paris  green,  antidote  for 112 

Pearlash,  antidote  for 114 

Peroxide  of  hydrogen 97 

Personal  cleanliness 11 

Piles 41 

Poison  ivy 34 

Poisons: 

Antidotes  for Ill 

General  consideration 110 

Pott's  fracture 73 

Precautions,  list  of 114 

Prophylaxis,  venereal 50 

Ptomaine  poison 114 

Quinsy 25 

Ratsbane,  antidote  for 112 

Rheumatism 42 

Rib,  fracture 63 

Rough  on  rats,  antidote  for 112 

Rupture 95 

St .  Anthony's  fire  (erysipelas) 34 

Sanitation 9 

Scalds ^6 

Scalp  wounds SI 

Scarlet  fever 22 

Scurvy 42 


Shoulder: 

Dislocation 76 

Spraia SO 

SkuU,  fracture 62 

Sm.aUpox 18 

Sore  throat 25 

Sprains 80 

Sterilizing,  dressings  and  instruments 98 

Stings 93 

Stricture  of  urethra 49 

Strychniue,  antidote  for 113 

Sulphuric  acid,  antidote  for 113 

Sunstroke 32 

Supplies: 

Care  of 8 

Surgical,  list 7 

Syphilis 45 

Syphilitic  rheumatism 45 

Teeth: 

Care  of '..  11 

Toothache 11 

Thermometer 13 

Thigh,  fracture 67 

Throat,  foreign  body  in S4 

Thimib: 

Dislocation 75 

Fracture 63 

Toes,  dislocation 78 

Tonsillitis 25 

Toothache 11 

Transportation  of  injured 108 

Tuberculosis 28 

Turpentine 97 

Typhoid  fever 29 

Prevention  of 30 

Vaccination 21 

Venereal  prophylaxis 50 

Wounds 81 

Dressing  of 96 

Wrist: 

Dislocation 75 

Sprain SO 


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